Thump, All Better [EKG Strip]

I started my first day on the Electrophysiology consult service (or “EP” for short). The picture above is from my iPhone. It is an ambulance EKG strip from the first patient that I saw on the service. The patient had a history of CAD and presented with angina.

Now any medical student with half a brain would look at the first half of that strip and think that it was, “Torsades.” That’s what I said at least. However, I was quickly corrected and told that true Torsades requires evidence of a prolonged QT interval, which the patient did not have. Furthermore, it is quite unusual for true Torsades to be triggered by cardiac ischemia.

“How about polymorphic VT?”

“Sure. That would be much more likely. But…”

The attending pulled out her calipers and marched them down the strip. “But…I think this is something else.”

Any guesses?