Tag: mors
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Patient: n/a
ECG discussion: The top strip starts with sinus rhythm at ca. 75 bpm. Note that this generates a mean arterial pressure (MAP) of only 18 mmHg. A marked horizontal ST depression is also seen, which correlates with the pleth signal showing SpO2 of 74%. After 8 beats, there is no visible sinus activity any longer. No junctional escape rhythm is initiated, which indicates that the atrioventricular junction is also poorly perfused and suffering. The following beats are wide and slow, at only 35 bpm. Even though they resemble a ventricular/Purkinje escape rhythm by their morphology and regularity, this electrical activity is not able to create myocardial contraction. In the second strip, MAP is 13 and flatlined. This is explained electrophysiologically as electromechanical dissociation (EMD), which is similar to the term pulseless electrical activity (PEA).
The final (bottom) strip shows how the electrical activity ceases. Although mechanical asystole probably has happened already (hard to say without echocardiography), electric asystole has now also occured. Note that at the end of the strip the pleth wave is also flat.
September 8, 2009
ECG limb leads tracings from a middle-aged man with who went into cardiac arrest in his home. The patient was resuscitatated and transported to the hospital, but cardiac arrest occured during catheterization. Angiography showed 100 % occlusion of the distal LMCA and proximal LAD. Despite PCI and several hours of ACLS, success was not achieved.
These tracings show EMD/PEA, as the patient was pulseless at the time. Notice how the PEA slowes down, evolving more and more into a flatline ECG.
December 8, 2008
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Patient: Elderly male person with no known cardiac disorders. Presented in the ER with pressing, retrosternal chestpain, non-radiating. He is fatigued, with pale skin and mild diaphoresis. No dyspnoea or cyanosis. He is normotensive. Initial ECG is completely normal. After three hours, sudden and unexpected cardiac arrest occurs. Eccocardiogram shows cardiac tamponade, probably due to rupture of proximal aorta. Resuscitation is unsuccessful. This ECG recording was made when resuscitation ended, one hour after cardiac arrest occured.
ECG description: The ECG shows a broad complexed and slow rhythm. The patient is apneic and pulseless, and yet there appears to be electrical activity in the heart. There has occured an electromechanical dissociation in the heart, as the electrical impulses do not lead to contractions. Cardiac output is none. This is called Pulseless Electrical Activity.
December 3, 2008