McGill Case 341

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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.

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This is a recording from an older man in the surgical intensive care unit. He was recovering from a motor vehicle accident where he sustained a chest injury from his seat belt. This recording was done after the administration of adenosine intravenously. This is an interesting cardiogram that shows the termination of a wide complex tachycardia with adenosine. The axis of the EKG is rightward and the QRS is wide at 130ms. Termination with adenosine suggests that this is a supraventricular arrhythmia that is reentrant. Note that the tacycardia slows before it terminates. The termination of the tachycardia is followed by a sinus node arrest and multiple ventricular escape beats. The first pair of beats after the termination of the tachycardia are probably an escape ventricular beat followed by a single echo beat. The second to last beat to the right is the only clear sinus beat. This patient had a bifasicular block in sinus rhythm.