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April 2010 EKG Case The following EKG is obtained 1 hour after treating a 76 year old man with fibrinolytics. What does the EKG show and what is your diagnosis? Rate: 110-120 Rhythm: regular wide complex tachycardia Axis: right axis deviation PR: no clear p waves ST: depressed in V1,V2,V3, elevated in V5,V6 QRS: wide EKG Diagnosis: accelerated idioventricular rhythm (AIVR) Clinical Diagnosis: This is a reperfusion dysrhythmia Treatment: This dysrhythmia is common after reperfusion with thrombolytics and is often transient and resolves spontaneously within minutes. Patients usually remain hemodynamically stable. The differential of regular wide complex tachycardias includes ventricular tachycardia which is treated with antiarrhythmics (amiodarone, lidocaine or procainamide). However, V. tach. has to have a rate > 120 beats per minute. Idioventricular rhythms have rates of 20-40, but accelerated idioventricular rhythms have rates between 40-120. AIVR is a common reperfusion arrhythmia which should not be treated with antiarrhythmics as these can lead to asystole and cause death. |