ECG of the Week

34yo lady who is 36/40 pregnant presents with nausea, vomiting and left-sided chest discomfort. She has been vomiting for 12 hours. Her systolic BP is 95mmHg.

1) Describe the ECG

Narrow complex tachycardia, i.e. SVT

2) What would be your initial management?

• Move to Resus cubicle

• IV fluids

• Correct electrolytes

• Call O&G

• Attempt Valsalva manouevre (there’s a new kid on the block if the modified Valsalva doesn’t work — it’s called the reverse vagal maneouvre)

3) If this patient became hypotensive, what would you do?

• Alert O&G and Paeds teams about the potential impending need for an emergency C-section

• Call Cardiology for advice

• Adenosine is the drug of choice => If that fails, DC cardiovert

• Monitor the foetus throughout

Image of the Week

22yo lady presented with 3 days of SOB and dizziness. Vital signs are RR 16, SpO2 100%, HR 93.

1) Describe the image and the abnormality seen

• Axial view of CTPA showing the right pulmonary artery and part of the left pulmonary artery

• Non-occlusive embolus in the right pulmonary artery

2) What possible findings may be seen on an ECG of this patient?

• Nothing abnormal

• Sinus tachycardia

• Right axis deviation

• RBBB

• Anteroseptal ST elevation or depression

• Anteroseptal T wave inversion

• S1Q3T3

• Likely PEA or asystole in cardiac arrest

3) What findings seen on TTE or CT may suggest right heart strain? Give 3 answers.

• Abnormal position or flattening of interventricular septum

• Right ventricular enlargement (bigger than left)

• Pulmonary trunk enlargement (bigger than aorta)