Concluded Case

IRREGULAR CARDIAC RHYTHM

A 30 years old male patient, complaining with pain abdo. RIF tenderness. Usg show appendicitis. O/E BP 120/70mmHg Pulse 42bpm Spo2 99% Chest B/L clear We plan for appendectomy, but abnormalities seen in ecg & echo. What will be the management .....????

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Concluded answer

NICELY .. MANAGED..... THANKS. FOR SHARING Dr @ MAQUSUD. ANSARI JI

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It is SA block.sino atreal block.if susrgey to be done on emergency basis u can proceed .pl keep a close watch continuously monitoring with a specialist beside the ot table. If he develops any Brady arrhythmia it can be tackled on the spot. Pl take high risk consent from the relatives with proper counseling with positive approach.we come across many cases of SA block in routine practice who are asymptomatic

Sir,in this case surgery is specially risky when done under spinal anesthesia,I wont recommend without tmp
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Each QRS complex is preceded by P wave Therefore it is sinus rhythm However QRS complex are coming at irregular interval and long gap between two QRS complexes, this is because P wave is not generated properly at sinus node Impression Sick sinus syndrome with bradycardia Adv Pacemaker insertion This is more important and life threatening than surgery of appendicitis

Can we conclude on this ecg without long lead that this patient has sick sinus syndrome
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Irregular cardiac rhythm show in ecg 2decho done but its doesn't show any cad or ischemic changes No in such case see electrolyte that will be one reason for irregular rhythm And plan for open appendectomy after seeing electrolyte If there is any deviation in electrolyte correct electrolyte N treat accordingly

NSR LAD SINUS ARREST Needs rhythm strip . Since acute appendicitis is an emergency, surgery can be done under spinal with cardiac monitoring. Open surgery will be safer than lap surgery.

Thank you,Doctor
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Bradyarrthmia Tab ventoline 4mg.bd Placement of TPM and urgent appendectomy.. After appendectomy, electrophysiological studies of heart.

NICELY .. MANAGED..... THANKS. FOR SHARING Dr @ MAQUSUD. ANSARI JI

Electrolyte imbalances. Pl.check and correct. Echo cardiography is advised.

NSR Rythm is regularly irregular It is RBBB2:1 Sinus bradycardia

Thanx dr Maqusud Ansari
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Check for electrolytes and treat imbalances accordingly

GO FOR ELECTROLYTES SIR

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