An 81-year-old male presented to the emergency department with recurrent syncope. Two weeks prior, he had undergone successful elective cardioversion for atrial flutter, and his medication was switched from bisoprolol 2.5 mg once daily to sotalol 80 mg three times a day. During transport to the hospital, he was resuscitated and defibrillated. Upon presentation to the emergency department, the patient experienced no cardiac symptoms and was hemodynamically stable. Physical examination revealed no abnormalities except for a decreased heart rate of 40 bpm (Fig. 1a). Laboratory investigation showed borderline normal values of magnesium (0.71 mmol/l: reference values: 0.70–1.00) and potassium (3.5 mmol/l; reference values: 3.5–5.0) and mildly reduced kidney function (serum creatinine: 114 μmol/l; reference values: 50–110). While at the emergency department, he lost consciousness. The electrocardiogram (ECG) recorded at that time is shown in Fig. 1b.
Fig. 1
Electrocardiograms (a) at presentation at the emergency department and (b) during syncope
×
How would you explain the T wave abnormalities in the first ECG (Fig. 1a), and what is the mechanism of the tachycardia visible in the second ECG (Fig. 1b)?
Answer
You will find the answer elsewhere in this issue.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
