Does occult VF occur and if so how does it appear on our ecgs?
This week's literature review is of a multicenter, prospective, observational trial in 28 Emergency Departments in the US and Canada.
The primary outcome of the study was to determine the prevalence of VF visualised on ECHO but not identified on ECG.
The results are compelling:
- 5.3% (43/811) (95%CI 3.9-7.1) of patients had occult VF
- The ecg findings in those patients were: PEA or Asystole.
- 61.4% (124) who had ECG VF showed no VF on ECHO.
- Survival to discharge for all patients was 3.1%(25/811)
Read my review and a discussion of the limitations here.
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Acute Aortic Syndrome
Acute aortic syndromes comprise 3 life-threatening entities:
1. Acute Aortic Dissection (AAD)
- Represents 80% of acute aortic injuries
- 12% will also have intramural haematoma and penetrating aortic ulcer
- Critical timing: Type A dissections have 1-2% per hour mortality increase for first 48 hours
2. Intramural Haematoma (IMH)
3. Penetrating Aortic Ulcer (PAU)
- 7% of aortic syndromes
- Can progress to AAD, IMH, or aortic rupture
- Up to 60% will have a concurrent aortic aneurysm
Key point: These entities exist on a continuum and can progress from one to another or co-exist.
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ECG Challenge
A 12 yo boy presents with an episode of syncope during exertion exercise. Whilst in the emergency department he develops palpitations and an ecg is done. What does the ECG show?.
Answer
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This is bidirectional ventricular tachycardia, similar to what may occur, with digoxin toxicity.
It is Catecholamine induced polymorphic tachycardia.
If untreated, it carries a 30% mortality.
It is a stress induced tachycardia that can lead to syncope or cardiac arrest and patients can suffer a VF arrest or sudden cardiac death.
​Treatment is initially with a beta blocker such as Propranolol or Atenolol. If this fails to control the arrhythmia an implantable defibrillator may be needed.
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A/Prof Peter Kas
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