A 75-year-old lady with a history of hypothyroidism (HT) presents with a period of a brief loss of consciousness after getting up from a chair to answer the phone. She became dizzy and passed out for a few minutes. She denies palpitations, chest pain, or shortness of breath. Her blood pressure (BP) is 138/68 and fell to 118/68 upon standing. The 12-lead electrocardiogram (ECG) is as follows:
Question 1: The ECG shows
Initial telemetry in the hospital was unremarkable. An event recorder was requested. The transmission is as follows:
Question (2) The above recording shows:
The patient went into cardiac arrest, and after 6 minutes of cardiopulmonary resuscitation (CPR) and defibrillation, a return of spontaneous circulation was achieved. Blood electrolytes were normal. Below is a post-resuscitation ECG.
Question 1 Answer: Left bundle branch block (LBBB) with first-degree heart block
Question 2 Answer: Ventricular standstill and torsades de pointes
Ventricular standstill is an arrhythmia that is potentially fatal and often associated with syncope. Torsades de Pointes is polymorphic ventricular tachycardia that may terminate spontaneously or worsen into ventricular fibrillation.