Thursday, March 3, 2016

What changed in the second echo clip?

A young adult was brought to the ED with seizure versus syncope, and an echocardiogram was performed. 

These two clips were obtained within seconds of each other, and I've combined them in sequence here. Of course, color Doppler is being employed in the second clip, but there is a subtle abnormality.

Perhaps it would be helpful to see the cardiac rhythms. 

During the first clip, the monitor showed:

During the second clip, however, the monitor showed:

These show, respectively, a long QTc and Torsades de Pointes. The patient had no pulse during the second recording.

Looking back at the second clip, the septal and lateral walls can be seen oscillating at a rate far faster than the opening and closing of the aortic and mitral valves. Here is a slowed-down version:


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