Puzzle 2004 2 73, A fainting lady with some extrasystoles - Answer: Difference between revisions
Puzzle 2004 2 73, A fainting lady with some extrasystoles - Answer (view source)
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The ECG shows a sinus rhythm of 100 beats/min. | {{NHJ| | ||
The electrical axis is intermediate (positive QRS | |mainauthor= '''A.A.M. Wilde''' and '''H. Tan''' | ||
complexes in leads I and aVF). The PQ interval is | |edition= 2004:2,73 | ||
slightly prolonged; the QRS width and morphology are | }} | ||
normal. The ST-T segment looks normal and the QT | [[Image:Puzzle 2004 2 73.jpg|thumb|Figure 1]] | ||
interval is certainly not prolonged. | |||
There are two episodes of tachycardia with four | A30-year-old woman presents with repeated syncope. Her symptoms started a few months ago without a particular trigger. The repeated episodes are not preceded by triggers either. Occasionally she experiences some palpitations followed by dizziness or syncope. She feels healthy otherwise, has no relevant medical history and is not taking any medication. Physical examination reveals no abnormalities, nor does laboratory investigation or echocardiography. Her ECG is presented: leads II, III, aVF, and V4 to V6 | ||
broad QRS complexes and two isolated broad | are shown, calibration is given in the margin. | ||
complexes with a similar morphology as the initiating | |||
beats of the tachycardia. The first two episodes have a | '''What is your diagnosis and what would your treatment be?''' | ||
changing morphology resembling torsades de pointes | |||
(TdP) and pointing to a ventricular origin. However, | ==Answer== | ||
there are four important differences from what is | |||
usually referred to as TdP. | The ECG shows a sinus rhythm of 100 beats/min. The electrical axis is intermediate (positive QRS complexes in leads I and aVF). The PQ interval is slightly prolonged; the QRS width and morphology are normal. The ST-T segment looks normal and the QT interval is certainly not prolonged. There are two episodes of tachycardia with four broad QRS complexes and two isolated broad complexes with a similar morphology as the initiating beats of the tachycardia. The first two episodes have a changing morphology resembling torsades de pointes (TdP) and pointing to a ventricular origin. However, there are four important differences from what is usually referred to as TdP. | ||
#There is no long QT interval and | #There is no long QT interval and | ||
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Recently, it has been suggested that the arrhythmia | Recently, it has been suggested that the arrhythmia | ||
may be cured by radiofrequency catheter ablation. | may be cured by radiofrequency catheter ablation.<cite>Haissaguerre</cite> | ||
Indeed, the monomorphic appearance of the initiating | Indeed, the monomorphic appearance of the initiating | ||
extrasystoles suggests a localised ventricular origin. | extrasystoles suggests a localised ventricular origin. | ||
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arrhythmia recurrence). Long-term follow-up has to | arrhythmia recurrence). Long-term follow-up has to | ||
be awaited before the patient can be discharged without | be awaited before the patient can be discharged without | ||
an ICD.<cite>Leenhardt</cite> | an ICD.<cite>Leenhardt</cite> | ||
==References== | ==References== | ||
<biblio> | <biblio> | ||