Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics

A 70 year old male with a history of ischemic heart disease presents with chest pain, dizziness and palpitations.  He is diaphoretic, short of breath, and has a blood pressure of 100/60 mm Hg.

What does the EKG show and what is the diagnosis?

Rate:    150

Rhythm:    ventricular tachycardia

Axis:    extreme left axis

P:     not seen

QRS:     wide complex

EKG diagnosis:   Ventricular tachycardia

Clinical diagnosis:  1) Ventricular tachycardia

     2)  Ischemic heart disease

Treatment:   Defibrillation

     Antiarrythmics

Where would you expect to find somatic dysfunctions in chest pain patients (not necessarily this patient)?

Answer:  T1 – T4

Practice Points:     -A wide complex regular tachycardia in a patient over 35 years old with a history of ischemic heart disease is ventricular tachycardia until proven otherwise

• aVR is positive, indicative of extreme left axis deviation---supporting the diagnosis of VT
• The monophasic R in V1 is suggestive of VT.  Biphasic complexes (QR or RS) in V1 also suggest VT.

• Triphasic complexes in V1 suggest VT when the pattern is Rr. SVT is suggested when the pattern is rR.

• Concordance---the QRS deflections in V1 thru V6 are all positive or are all negative also suggests VT.

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