The initial ECG was taken on presentation to the Emergency Department and the second ECG was performed several hours later. The patient was asymptomatic on both occasions with a normal blood pressure.
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Initial ECG on presentation
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- Bradycardia - mean ventricular rate 54 bpm
- Marked sinus arrhythmia
- ~2 sec pause between 1st and 2nd complex
- Inferior axis
- 1st Degree AV block - varying magnitude 220-280 ms
- Right bundle branch block
- Discordant ST / T wave changes
- ST Elevation leads aVR, aVL
- ST Depression leads II, III, aVF, V6 with T wave inversion
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ECG several hours later
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- Bradycardia - mean ventricular rate 36 bpm
- Marked sinus arrhythmia
- Morphology of axis, QRS, ST segments and T waves same as prior ECG
Interpretation:
- Sinus Node Dysfunction
- Marked sinus bradycardia
- History of collapse / syncope
What happened ?
The patient remained asymptomatic during episodes of bradycardia. There were no correctable electrolyte abnormalities or culprit medications to account for bradycardia.<35 a="" an="" and="" bpm="" bradycardia="" cardiac="" chamber="" diagnosis="" dual="" during="" dysfunction="" font="" given="" his="" history="" hospitalization.="" insertion.="" made="" marked="" node="" noted="" of="" on="" pacemaker="" patient="" sinus="" syncope="" telemetry="" the="" underwent="" uneventful="" was="">
A diagnosis of sinus node dysfunction was made and a dual chamber pacemaker was inserted. The patient made an uneventful post-procedural recovery and was discharged home following a brief in-patient stay.
References / Further Reading
Life in the Fast Lane
Textbook- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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