Unrecognized Killers in Emergency Electrocardiography, Part II

ECG Weekly Workout with Dr. Amal Mattu

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HPI

A 46-year-old woman presents after two syncopal episodes associated with palpitations. She reports feeling a rapid heart rate before losing consciousness. She has a few witnessed episodes in the emergency department and is noted to have brief episodes of polymorphic VT that result in syncope but self terminate. The following ECG is obtained between episodes:

Before watching this week’s workout, carefully review the ECG and consider the following:

1. 1. What is your ECG interpretation and the most likely cause of this patient’s symptoms?
   2. She is suspected of having Torsades de Pointes and is treated with multiple bolus doses of IV magnesium, but continues to have recurrent syncope and episodes of polymorphic VT. How would you manage this patient?