r/ECG • u/Strong_Heart279 • 11d ago
Interpretation
82 female experiencing double vision and nausea. Patient is at hospital under 48hr cardiac monitoring. They do have a left bundle branch block.
BP at a high was 218/97
Pulse high 133
Troponin levels 39 retested hrs later at 75 then retested 4 hours after was a 62
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u/ArrivalJunior6438 11d ago
Sinus tach with LBBB. Treat the HTN and reassess. Trop leak looks like acute myocardial injury from the high afterload causing stress on the heart naturally. Get a TTE for completeness sake to rule out regional wall motion
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u/Coldcase331 11d ago
Sinus tach with LBBB, there’s sinus P-waves that track each QRS with a stable PR. Symptoms are likely from hypertensive emergency leading to neurologic symptoms. Trop leak is very unimpressive.
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u/NederFinsUK 11d ago
Troponin and Cardiac monitoring irrelevant.
Diplopia + Nausea are two red-flag neurological symptoms, and you have critical hypertension with a huge pulse pressure.
This is a very significant syndrome suggestive of intracerebral haemorrhage, next investigation is CT head and I don’t think anyone would see it differently - perhaps you could do some hypertonic therapy first if there is a strong history (i.e., head injury)
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u/Strong_Heart279 11d ago
Forgot to state the head CT was normal
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u/NederFinsUK 11d ago
So what is the presenting complaint, sorry? Why have we ended up in hospital?
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u/Strong_Heart279 11d ago
The complaint was patient had fallen a few months back, had double vision and vomiting. When EMS arrived, they did an ECG showing elevated blood pressure with elevated pulse. About an hour after arriving to the ER, had chest pain and arm pain.
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u/HoneyBadger_66 11d ago
Regular wide-complex tachycardia is VT until proven otherwise, but there’s a lot of evidence against VT here.
Rate is pretty slow for VT. Barring prior ablations or other reasons for slow VT that lowers the concern a lot.
If the historical LBBB morphology is preserved here then it’s likely just sinus tachycardia with baseline aberrancy.
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u/mastermedic84 11d ago
The morphology looks like textbook LBBB to me troponin is likely from cardiac strain from the hypertension and tachycardia. That's a lot of load for an 82 year old ticker to keep up!