September 19, 2013

ECG: Third Degree Heart Block

This 70 years old gentleman who is a smoker but no known medical illness presented with severe giddiness for 4 days associated with epigastric discomfort, shortness of breath, orthopnoea and paroxysmal nocturnal dyspnoea.

On examination, he is conscious and alert, pink, hydration and perfusion status is good. pulse volume is low. Blood pressure is 100/70, Pulse rate is 34, respiratory rate is 28, SPO2 is 100% under room air.

No murmurs or basal crepitation heard.

ECG shows sinus bradycardia with atrial rate is about 70. Ventricular rate is about 33. There is AV dissociation (atrial impulse is not conducting to ventricular impulse). Occasional ventricular impulse are seen.

A diagnosis of symptomatic bradycardia secondary to complete heart block was made and the aetiology could be due to underlying ACS in view of risk factor (Age, smoker, male)

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