Man Found Unconscious In a Park

ANSWER

The ECG shows atrial fibrillation with a controlled ventricular response, a significantly prolonged QTc interval, and deep ST-T wave changes. The patient has chronic atrial fibrillation with a controlled ventricular response, so this arrhythmia is not unusual.

The deep ST-T wave changes and a prolonged QTc interval not seen on the previous ECG are consistent with a central nervous system injury. Cerebral disorders affect ventricular repolarization, as evidenced by depressed ST segments, flat or inverted T waves, and prolongation of the QTc interval. It is important to note that ST-segment elevations and deep T-wave changes do not always signify myocardial ischemia or injury.

This patient’s CT and MRI scans of the head showed no evidence of an intracranial bleed or cerebrovascular accident. A subsequent EEG showed epileptiform discharges, but no seizure activity.

The most likely cause of the ST-T wave changes is global intracranial hypoperfusion as a result of ventricular fibrillation with a prolonged resuscitation period. Over the course of the following two weeks, the ST-T wave changes and QTc prolongation normalized.