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A 44-year-old female presented to the emergency room after falling down the stairs at home for an unknown reason. The patient was found by her partner 6 h after the fall, whereupon he called for an ambulance. The cardiologist was consulted because of her abnormal electrocardiogram (Figs. 1 and 2). The patient had a history of depression, for which she did not take medication. There was no cardiac history, and no prior electrocardiograms were available for comparison. She complained of nausea and vomiting. During trauma assessment using the ABCDE approach, the patient’s airways and breathing were stable without support. Circulation was hampered by bradycardia of around 30 bpm and hypotension with a systemic blood pressure of 70/50 mm Hg, for which norepinephrine was uptitrated. Disability assessment revealed impaired consciousness, with a Glasgow Coma Score of 13 (E3M6V4) and time disorientation. Exposure showed facial lacerations. The paramedics reported not seeing pills or drugs at her home that may have caused intoxication.
1.
What is your differential diagnosis based on the electrocardiographic findings?
2.
What would be your next steps or what treatment would you initiate?
Fig. 1
Ambulance electrocardiograms (25 mm/s, 10 mm/mV)
Fig. 2
Electrocardiogram obtained in trauma room (25 mm/s, 10 mm/mV, 0.05 Hz high-pass filter for baseline noise removal, 150 Hz low-pass filter for high-frequency noise suppression)
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Answer
You will find the answer elsewhere in this issue.
Conflict of interest
A. van Veelen, J. Elias, P.G. Postema and M.C. van de Veerdonk declare that they have no competing interests.
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 ...
