This ECG is from a 64 year old male.
Presented following multiple episodes of syncope.
|Click to enlarge|
- ~42 bpm mean ventricular rate
- Junctional escape rhythm
- Complexes number 1, 3, 4, 5
- Rate ~ 36 bpm
- Complexes number 2, 6, 7
- Normal (~70 deg)
- PR - Upper limit normal where present (~200ms)
- QRS - Normal (100ms)
- QT - 520ms
- ST Sagging leads II,III,aVF,V5-6
- T wave notching in leads V1-3 in 5th complex likely secondary to lead transition
- Biphasic T wave V1
- P waves broad & notched
- Intermittent sinus arrest with junctional escape rhythm
What happened ?
This ECG was captured during a symptomatic episode of presyncope.
The patient then spontaneously reverted to sinus rhythm after a few minutes.
His beta-blocker was ceased and he was transferred for PPM insertion.
A 64 year old male presents to your ED following an episode of syncope.
He complains of feeling lighted.
BP 105/60 RR 18 Sats 96% Room Air
a) Describe & interpret his ECG (50%)
b) Outline your management (50%)
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.