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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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Authors: '''A.A.M. Wilde''' and '''H.L. Tan''', Cardiologists, AMC, Amsterdam, The Netherlands | Authors: '''A.A.M. Wilde''' and '''H.L. Tan''', Cardiologists, AMC, Amsterdam, The Netherlands | ||
[[Image:Puzzle 2004 2 73.jpg|thumb|Figure 1]] | |||
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 | |||
are shown, calibration is given in the margin. What is | |||
your diagnosis and what would your treatment be? | |||
==Answer== | |||
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. | 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. | ||