ECG Of The Month: Sepsis, ARDS, and Tracheal Intubation.

A furuncle on the leg of a 23-year-old woman led to methicillin-resistant staphylococcus aureus sepsis and adult respiratory distress syndrome (ARDS) requiring tracheal intubation in the intensive care unit (ICU). Initially her electrocardiograms (ECGs) showed sinus tachycardia, but otherwise were unchanged from prior ECGs. A week into her ICU stay a different rhythm occurred.

Electrocardiogram in a Young Woman With the Eisenmenger Syndrome.

A young woman with an atrial septal defect and the Eisenmenger syndrome has worsening symptoms and electrocardiographic changes of right ventricular hypertrophy five years later.

Leg Pain in a Manual Laborer.

A man admitted for deep vein thrombosis of his leg is found to have an important unrelated electrocardiographic abnormality. In the second paragraph, either reinsert the comma after V1 in the fifth line or remove the comma after enlargement in the fourth line.

ECG of the month. Cardiac failure and stroke in a 43-year-old woman. Coarse atrial fibrillation indicating left atrial enlargement and left ventricular hypertrophy with repolarization abnormality.

A 43-year-old woman with a long history of heavy cigarette smoking was in good health until she developed fatigue, dyspnea on exertion, and paroxysmal nocturnal dyspnea approximately three months before admission to our hospital. Four weeks before admission, she was admitted to another hospital for the sudden onset of a right hemiparesis. She was noted to be in atrial fibrillation, and cardiac catheterization and angiocardiography revealed triple-vessel coronary arterial disease and moderately severe mitral regurgitation. Because of repeated episodes of paroxysmal nocturnal dyspnea, she was referred to our hospital for cardiac surgery. On admission, an electrocardiogram was recorded (Figure).

ECG of the month. Bigeminal rhythm VIII. Sinus rhythm with normal antegrade atrioventricular (A-V) conduction and slow retrograde conduction back to the atria, producing atrial reentry or echo complexes and suggesting dual A-V nodal pathways or an accessory A-V pathway that conducts slowly from the ventricles to the atria.

A 55-year-old woman came to the emergency department because of an episode of post-prandial upper abdominal pain radiating to her back and associated with nausea and vomiting. The pain had been recurring intermittently for approximately six months. While in the emergency department, she had another episode of pain and felt lightheaded. Her pulse rate at that point was between 30 and 40 beats per minute, and an electrocardiogram was recorded (Figure).