Document Detail


Lewis Lead Enhances Atrial Activity Detection in Wide QRS Tachycardia.
MedLine Citation:
PMID:  20022196     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: The differential diagnosis of wide QRS tachycardia is a challenge for the emergency physician. The major tool is the electrocardiogram (ECG), even though the sensitivity and specificity may be variable, depending on presentation. Additional leads could be used to improve the diagnostic accuracy of the ECG. Objective: To document the use of the Lewis lead in improving the diagnostic accuracy of the ECG in wide QRS tachycardia. Case report: A 52-year-old woman with rheumatoid arthritis, in treatment with methotrexate, was admitted with progressive dyspnea that evolved to acute respiratory distress and shock at arrival. Pneumonia was diagnosed as the infection and she received antibiotics, and respiratory and inotropic support. She was also using amiodarone for more than 10 years, but she couldn't state the reason. On cardiac monitoring, wide QRS tachycardia was detected and ventricular tachycardia was considered on the differential diagnosis. The standard 12-lead ECG was complemented with the Lewis lead, obtained with higher speed and amplitude, demonstrating atrioventricular concordance and excluding ventricular tachycardia. The patient was treated for septic shock, and she died 2 days later. Conclusion: The Lewis lead is a simple and easy strategy to enhance atrial activity detection in wide QRS tachycardia.
Authors:
Wallace Rodrigues de Holanda-Miranda; Felipe Magalhães Furtado; Paula Menezes Luciano; Antonio Pazin-Filho
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Publication Detail:
Type:  Journal Article     Date:  2009-12-21
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  43     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e97-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Clinical Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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