No abstract

No abstract

SE is a significant, likely underdiagnosed, predictor of morbidity and mortality after ICH. Future studies are necessary to better identify which patients are at highest risk of SE to guide resource utilization.

A woman in her 40s with a medical history of infective endocarditis and hepatitis C secondary to ongoing intravenous drug use presented to the emergency department with severe back pain and evidence of vertebral osteomyelitis/diskitis. She was hospitalized and treated for Staphylococcus aureus bacteremia. Transesophageal echocardiography findings revealed pulmonic valve vegetations and severe tricuspid valve regurgitation secondary to a flail leaflet. She underwent 6 weeks of intravenous antibiotic treatment and subsequent tricuspid valve replacement with a 29-mm bioprosthetic Carpentier-Edwards valve complicated by transient third-degree heart block. Two days after pacemaker placement, she had episodes of light-headednessandchestpainwithheartratesbetween150and190beats per minute. Her blood pressure was 94/60 mm Hg. The electrocardiogram during tachycardia is presented in Figure 1.Question: What is the rhythm demonstrated on the electrocardiogram? InterpretationThe P waves are upright in leads II, III, and aVF, suggesting an origin in the sinus node with a rate of 96 beats per minute. Grouped beating is apparent, with 1 P wave producing 2 QRS complexes, giving rise to the regularly irregular rhythm. This pattern is diagnostic of dual atrioventricular (AV) nonreentrant tachycardia.