Thoughts ? Differential diagnosis ?
|Click to enlarge|
- Atrial Rate 83 bpm
- Ventricular rate 42 bpm
- No relationship between P waves : QRS complexes
- Normal (~65 deg)
- PR - No relationship
- QRS - Normal (80ms)
- QT - 440ms (QTc Bazette ~ 390 ms)
- Apparent ST elevation in V3 although likely to be secondary to p wave superimposition
- Complete heart block with junctional escape rhythm.
- Cardiotoxic agents
- Delibrate Self Harm
- Electrolye / Acid-base disturbance
- Aortic Valve Disease
- Congenital Cardiac Disease - Valvular or EP disturbance
- Thyroid Dysfunction - Hyper- or hypo-
- Stress Echo - Nil evidence ischaemia with normal LVEF
- Cardiac MRI - Nil evidence sarcoidosis
- PET Scan - Nil evidence sarcoidosis
- Nil reversible / correctable cause found for CHB
- Dual chamber PPM Implanted (MRI Compatible)
Don't forget to check out Christopher's works over at http://sixlettervariable.blogspot.com.au/ and if his Blogger profile is right, over here as well Paramedicine101.
Check out Vince's Google+ ECG+ Community for more excellent ECG discussions, and check out his website The Medical Appraoch to EM. You can also follow Vince on twitter @MedicalApproach
Thanks to Dr Shakeeb Razak for sharing this interesting case.
References / Further Reading
Life in the Fast Lane
- Complete heart block here
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.