60y/o male present to ER with SOB, coughing, dx with Acute heart failure. HIV+, recently in the hospital with similar diagnosis requiring mechanical intubation. Due to cough, fever and HIV with unknown CD4 count, CT chest order. Upon returning to unit, patient extremely out of breath, CP, hypertensive 200/100, HR and rythm as above, crackles, wheezy, Sp02 96% on 5L. There is no information available, no labs, other than what is presented, what does the ECG show? Should you be concern about ECG, yes or no? If yes, what criteria do you use to determine, if you should be concerned?

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Complete av dissociation Ventricular tachycardia Pt is hypertensive 200/100 P/h/o acute heart failure Severely breathless needed intubation Compermised status

Thanx dr Vedprakash Sharma
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Sir it's a case of idiopathic ventricular tachycardia / arthymias for this kind of pt ecg will be consern definitely as this kind of tachycardia will mostly arises from non structural disease of heart firstly now the patient is on ventilator give beta blockers as per the international protocol see for the rate if it's not getting in rate then next option will be catheter ablation

But it's bad case
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Monomorphic VT IV Cardurone bolus followed by Cardurone infusion If no response, Cardioversion , ICU MANAGEMENT Control of BP with IV Nitroglycerine, check electrolytes, check for Acidosis Zidavudine, stavudine, didanosine can cause myocardial damage by being mitochondrial toxins

Thank you
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SUGGESTIVE. OF AC. HEART. FAILURE HYPERTENSION HIV. FEVER. COUGH VENTRICULAR. TACHY ARRHYTHMIAS....

Its VT.has to be addressed immediately in icu.he is in cardiac failure. Pl push inj lasix 40mg iv pl push iv amiadrone 150mg bolus Infusion of amiadrone to be started If u can't achieve sinus rhythm pl go for DC shock. Once u achieve sinus rhythm pl control his blood pressure. Go for cardiac enzymes 2d echo

Patient has v tach With hypertensive response Control bp Cardarone 150 mg bolus sos repeat Keep negative with diuretics Get dine 2decho with cardiologist opinion Pro bnp Cxr Non invasive VENTILATION sos mechanical VENTILATION

HIV associated cardiomyopathy with LBBB

YES VENTRICULAR TACHYCARDIA

VT Lbbb Inferior wall ischemia

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