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ECG Abnormalities_Part 21

Saturday, July 21, 2012

69 year old female with a past history of breast cancer presents with dyspnea on exertion and dizziness. Her vital signs are BP 80/40, HR 120, RR 24, and oxygen saturation 88% on room air. Physical exam revealed crepitations at the left lung base, distant heart sounds, and elevated jugular venous pressures especially with inspiration. Her ECG is given below. Also provided is a simultaneous recording of her arterial line pressue tracing and inspirometer.
What are the abnormal ECG findings?
What is the diagnosis?

ANSWER

The ECG findings are:
1) Sinus tachycardia
2) Low voltage
3) PAC (2nd beat from the last on rhythm strip)
4) Poor R wave progression

Diagnosis is cardiac tamponade. Malignancy is the most common cause for a pericardial effusion resulting in increased intrapericardial pressures causing the right atrium and right ventricle to collapse in diastole.This results in hypotension and tachycardia and can be life threatening. The ECG findings of cardiac tamponade include low voltage on the ECG and "electricle alternans" where each QRS complex alternates from normal voltage to low voltage.Arterial line pressue tracing shows her systolic blood pressure dramtically drop with inspiration.This phenomenon which occurs in cardiac tamponade is called "pulsus paradoxus" and can be measured non-invasively using a blood pressure cuff.

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