McGill Case 341

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. Previous Case: McGill Case 340 | Next Case: McGill Case 342

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.