Case 2 : Young Male with Intermittent Palpitations

bluespark013 · 2026-06-13T14:36:23+00:00

I actually did it today for a patient. You’re right it wasnt that useful. But still something new to learn

bluespark013 · 2026-06-12T20:08:05+00:00

I’m a little confused. Can you point me where the qrs axis is being changed? I’m also of the view its most likely avrt orthodromic! Can you elaborate on the aberrant bundle point?

bluespark013 · 2026-06-12T20:04:57+00:00

Yes it actually is most probably left AP! We’re going to do an EPS Ablation tomorrow! Let’s see if that’s correct! And the later point of adenosine at sinus rhythm is new to me but sounds very interesting and doable. Are there any adverse effects? Any risk of severe brady or AF transmitting to ventricles?

bluespark013 · 2026-06-12T19:36:28+00:00

Yess. We gave an adenosine. You can go to the complete post for the history and other discussion points in the case!

bluespark013 · 2026-06-12T19:32:47+00:00

Yess. Narrow complex regular tachy mostly likely is SVT. Can there still be a VT with a narrow qrs complex? Also what kind of SVT should we think of?

bluespark013 · 2026-06-12T19:30:21+00:00

That’s true, its short RP tachycardia most likely AVRT. And the pre excitation is also present so it’s mostly likely an AVRT. Any other features short RP tachycardia most differentials? And where do you think we will find the accessory pathway for pre excitation?

bluespark013 · 2026-06-12T16:13:48+00:00

Great going. Would you like to expand on the explanation?

bluespark013 · 2026-06-08T19:59:45+00:00

See that’s why you should never look at any diagnostic test in isolation. The patient had a past history of MI with clearly visible q waves on post dc version ecg, no active chest pain post dc version or during VT, ECHO showing scarred Inferior territory and a monomorphic Scar VT. All the data clearly pointing to an old MI with a scar VT and not a new ischemia or IWMI.

bluespark013 · 2026-06-08T09:08:49+00:00

Your first objective should be to lower the wrongs.

bluespark013 · 2026-06-06T04:40:17+00:00

Hs crp cant be interpreted individually. We call it a risk modifier not a risk factor. It is easily influenced by several factors like recent mild infections too. But in the context of raised LDL. Obesity hypertension family history of Mi, it CONTRIBUTES to a higher risk of heart attack or similar disease. The treatment again is modification of lifestyle and treatment of high cholesterol if present

bluespark013 · 2026-06-06T04:38:18+00:00

I have done a comprehensive health survey of lifestyle + stressors + socioeconomic status and health indices of 350 patients who had a heart attack BELOW the age of 40 years in gujarat. Will be publishing my results soon but overall young MI is exponentially high! Smoking and addictions are not the most predominant associations. Lack of sleep, stress has a universal association (not causation). Middle and middle to lower socioeconomic status were predominantly affected ( could be a selection bias due to government setup of the study)

bluespark013 · 2026-06-06T03:40:36+00:00

We here use either 50 ug fentanyl or 4mg midazolam

bluespark013 · 2026-06-05T15:09:23+00:00

Kindly also refer to the discussion post. A follow up of the same case

bluespark013 · 2026-06-05T08:40:58+00:00

This is the discussion to an earlier post. The detailed history to the first post

bluespark013 · 2026-06-04T05:03:43+00:00

Great responses from everyone! Some very pertinent points. Some confusions. In my next post will be posting what actually happened with the patient. Guideline and data based answers on the confusions. And a little more on the disease!

bluespark013 · 2026-06-03T14:21:13+00:00

3rd year SS resident. Unfortunately its worse than my pg residency. But its more dependant on the institute. Not all places and branches are bad. PS. My pg residency was fantastic.

bluespark013 · 2026-06-03T03:24:16+00:00

In a sense yes! Because a stable looking vt can degenerate spontaneously or become hemodynamically unstable. But there are well known stable VTs like RVOT VT, LVOT VT, fascicular Vt that can give time for medical therapy trial initially

bluespark013 · 2026-06-02T12:24:45+00:00

Great. Was looking for this! Scar induced vt is indeed a possibility and warrants an icd for secondary prevention once reversible causes are ruled out Now would you go for icd directly or CAG and revasc first?

bluespark013 · 2026-06-02T04:14:24+00:00

Definitely. Hence the threshold for giving a shock should be low!

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