Monday, January 5, 2009

ECG Quiz

This is a 63 year old Chinese lady who presented with dizziness.


1. What does the ECG show ?



2. What is the treatment ?



7 comments:

huicy said...

sinus bradycardia with HR of 39 bpm. Normal axis. Regular.
AV dissociation.
Impression: Complete Heart Block

Mx: Pacemaker insertion

Wuchereria said...

Correct - it is a complete heart block and the treatment is a pacemaker insertion.

:)

Anonymous said...

may i know is there any right axis deviation? thanks

Axonopathic said...

To anonymous,

Thanks for the question. No, the axis is in the normal range ie -30 to +90 degree.

On the other hand, yes this patient does have partial RBBB to start with hence a RAD would pretty much be expected.

This is due to the fact that the ORSes are now foci of impulse generated from the diseased AV node or more distally, ie His bundle and its tributaries. Hence the impulses would be delayed, giving the apperance of bundle branch blocks. The appearance of the QRS would depend on the site of the BBB. The more distal the block, the wider the QRSes, implying a more diffuse disease.

I can conclude that this patient has a extensive degenerative disease of the conduction system involving the AV node and its distal tributaries. A permanent pacemaker would be mandatory in this case.

Clinical pearl here: THE WIDER THE QRS IN CHB, THE SLOWER THE ESCAPE RHYTHM AND HENCE THE HIGHER LIKELIHOOD OF ASYSTOLE.

Warm regards.

Anonymous said...

is ther ST deprsn in V2 V3 with R wave ? post: MI

shoan said...

hy said...u can see st depp.in v2 v3 and also v4 and a little v5 and invert t in v1 an flat t in avl and ur right this type III av block can caused by and ischemia.seems an osborn wave because of hypothermia maybe ,,,in v4 and v5 and a little one in v6.

Nitrile Gloves said...

I don't think, the lady has cardiac arrest problems. She might have some other problems that is related with her growing age.

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