ECG of the Week – 30th October 2019

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You are reviewing the ECG of an 82 year old man who has had an episode of syncope after a herald of spinning and dizzyness. He has had similar symptoms for the last 4 days, particularly when getting up out of bed.

Questions

Interpretation:

  • Rate: 66
  • Rhythm: AF
  • Axis: normal
  • Morphology: LBBB, inferolateral STD, nil scargbossa criteria
  • Intervals: QRS 150
  • Summary: AF

Further Managment / Clinical Closure:

  • 600mcg Atropine given -> HR31
  • ECG obtained as below:
    • Rate: Escape rhythm 30, Fib waves seen
    • Rhythm: AF with 3rd degree AV block and junctional escape rhythm with pre-existing LBBB
    • Summary: Regularised AF
  • Commenced on Isoprenaline as temporising measure after developed 30 seconds asystole.
  • Temporary pacing commenced.
  • PPM inserted after dependence on temporary pacing illustrated.
  • Dig levels normal in this patient

Further Reading – Textbook:

Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.