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Amiodarone vs Procainamide for Ventricular Tachycardia

The PROCAMIO Study(1) This was a randomised (non-blinded) open labelled study. 62 haemodynamically stable patients with sustained, monomorphic, Ventricular Tachycardia(VT), were assigned to receive either: (i) intravenous procainamide (single dose 10 mg/kg over 20 min) or (ii) intravenous amiodarone (single dose 5 mg/kg over 20 min). The study period was 40 min from infusion initiation…

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Thoracic Aortic Dissection: 5 things to make the diagnosis

CASE A 70 year old man, is brought to the Emergency Department by ambulance. He was drinking a coffee with friends and developed sudden severe chest pain. His past medical history is coronary artery disease and hypertension. He became hypotensive in the ambulance and was in some distress. He has had a bolus of fluid…

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The ECG of Pulmonary Embolism

There are several distinct ECG patterns in pulmonary embolism A CASE A 36 yo male presents to the emergency department with sharp central chest pain and shortness of breath. He works as a truck driver. He has no past medical history, is on no medications and normally very well, with no significant family history. An ECG…

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How To Read The Paediatric ECG

Below is an ECG taken of a 0ne week old infant, who has some shortness of breath whilst feeding according to the parents. What does it show? Is it normal?ECG’s can already present a significant challenge, however there is a fear associated with the paediatric ECG. There should not be, as the same principles that…

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Wolff-Parkinson-White

Introduction Wolff-Parkinson-White Syndrome occurs in about 0.3% of the population (1), although this is an underestimate, as evidence of pre-excitation on the ECG my be transient.  The characteristic delta wave indicates that the accessory pathway conducts faster than the Atrioventricular (AV) node, thus resulting in pre-excitation. However, the refractory period of the accessory pathway may…

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De Winter’s T waves

De Winter’s T Waves were first described by De Winter in an article to the editor of the New England Journal of Medicine in 2008(1). They are considered an ST-elevation myocardial infarction(STEMI) equivalent and knowledge of this sign is important as ST depression  is not the classic appearance of an STEMI. Using ECG’s from a large…

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Pericarditis, Benign Early Depolarisation or STEMI

Differentiating between Pericarditis, Benign Early Depolarisation and ST Elevation Myocardial Infarction can sometimes be difficult. CASE A 35 yo male presents with palpitations and pleuritic chest pain. He’s recently had a viral illness but has no other medical history. At 1am in the morning, the patient was woken by palpitations. He now complains of left…

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A New Way to Give Adenosine in SVT

I’ve been speaking and writing about Supra Ventricular Tachycardia(SVT)  a lot recently. Perhaps because of the number of cases coming in. Someone mentioned a new way to give adenosine for SVT. A recent post on Academic Life in Emergency Medicine, also mentioned this approach.   Traditionally we administer the adenosine in a 6mg  dose via…

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Electrolytes and the Heart

I was talking to a group of my junior registrars the other day about cardiac physiology, and I was struck by how much trouble they seemed to have relating electrolytes to the QRS complex. We sat down and nutted it all out which left everyone happy. The key to understanding the effects of electrolytes is…

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Supraventricular Tachycardia(SVT) in Infants

A mother brings her 7 month old son to the Emergency Department, as he has been irritable for the last 2 days.  There have been no major problems, apart from the irritability, that she can pinpoint, perhaps some slight feeding issues and some fever two days ago, but that is all. The local doctor had…

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