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Vomiting, dizzy spells and fainting. ECG is normal. What could this indicate?

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I am an EMT. Just attended an elderly patient with fainting & vomiting, dizzy spells. His ECG is normal, then he suddenly has a 20-30second run of rsr conplexes in V1 & V2 which accompanies his symptoms (pale sweaty dizzy vomiting). This self resolves and the symptoms dissipate. What could this indicate?
Posted Sat, 18 May 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later
Dear Sir
Thanks for writing to XXXXXXX

The symptoms mentioned by you are signs of low heart output (sweating/ dizziness /pallor).

The First possibility is that he had a Ventricular Tachycardia, where the rsr' complex in V1-2, would have accompanied a prolongation of duration of QRS complex and increase in the heart rate. It will also be showing either absence of P waves or the P waves will lose their 1:1 relationship with QRS complex. In this condition the pumping of heart reduces markedly due to 1. inability to fill properly due to short diastole (or period of relaxation or filling phase) 2. loss of atrial contribution 3. ineffective ventricular contractions.The most common cause for VT is anginal/coronary heart disease. A dilated dysfunctional heart (with decreased pumping) also predisposes to this condition.

Second less common possibility is that he had a supraventricular rhythm which may be irregular (like atrial fibrillation, with no P waves, irregularly irregular) or regular (Atrial flutter/ AV node dependent tachycardias) with rate related prolongation of QRS. These rhythms usually do not produce signs of low heart output (sweating/dizziness/pallor) unless patient has underlying "decreased heart pumping" (systolic failure) or marked relaxation abnormality/ diastolic dysfunction (as in aortic stenosis/ hypertrophic cardiomyopathy).

These rhythms may resolve spontaneously on their own.
If you can upload the ECGs, I would be glad to discuss more on this issue.
Sukhvinder Singh
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