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(A–D) Progression of 12-Lead ECG obtained from the same patient (Figure 5.41) over a 15-minute period. (A) ECG showing sinus tachycardia at a rate of 150 bpm and diffuse ST-T wave abnormalities. There is hyper-acute ST segment elevation suggesting myocardial injury or ischemia. (B) ECG obtained 5 minutes later demonstrates sinus tachycardia with ST elevation and ventricular bigeminy. (C) ECG obtained 5 minutes later shows wide complex tachycardia, possibly an accelerated idioventricular rhythm with ST elevation. (D) ECG showing ventricular tachycardia (after about 15 minutes from the initial presentation) associated with loss of consciousness. Even though the rate of the VT is slow, it is nevertheless an ominous sign. Patients with acute fulminant myocarditis can progress rapidly and the condition can be fatal if not appropriately managed. (Photo contributor: Shyam Sathanandam, MD.) Source: Chapter 5. Cardiology, Atlas of Pediatric Emergency Medicine, 2e Citation: Shah BR, Lucchesi M, Amodio J, Silverberg M. Atlas of Pediatric Emergency Medicine, 2e; 2013 Available at: Accessed: October 25, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved
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