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Orthopedics

December 2004 EKG case

 A 60 year old male is admitted for an anterior myocardial infarction and is thrombolysed. Twelve hours later, his EKG changes.   The patient has no further chest pain and has no signs of heart failure.  His blood pressure is 128/72.

What does the EKG show and what is the diagnosis?

Rate:    50

Rhythm:  idioventricular with occasional sinus beat

Axis:    Left axis

P:   Normal (when in sinus rhythm)

PR:    Normal (when in sinus rhythm)

QRS:   LBBB morphology

EKG diagnosis: Idioventricular rhythm

Clinical diagnosis:  Post-infarct idioventricular rhythm

Practice Points: - This is a common arrhythmia following myocardial infarction

• It is due to spontaneous pacemaker function originating within or below the AV node.
• It is not usually associated with hemodynamic compromise and does not require any treatment
• It is often seen as an escape phenomenon. Atropine will increase the sinus rate which will often abolish the idioventricular rhythm.

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