Case 100

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Look at the consecutive ECGs in this patient. What is the problem that causes the arrhythmia in rhythm strip 2?

Rhythm strip 1


Rhythm strip 2


Rhythm strip 3


Rhythm strip 4


Answer

  • The first rhythm strip shows sinusrhythm with a severely prolonged QT interval. In total four ventricular premature beats are present on this strip. All fall within the T wave of the previous sinus beat.
  • The second strip shows Torsade de Pointes with a typical short (not shown) - long - short initial sequence.
  • The third ECG shows severe QT prolongation with a stretched QT segment and small T wave, consistent with Type 2 LQTS.
  • The fourth ECG shows the same patient later in time.