Case 148: A 79 Year-Old Woman in Hospital with Palpitations
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
History
A 79 year-old woman is admitted to hospital with palpitations. Because of a previous history of atrial fibrillation, she had been started on a combination of flecainide and bisoprolol. She presented to the ER with palpitations that felt different from her original symptoms with atrial fibrillation. Her ECG is shown below:
Diagnosis
- Atrial tachycardia with 2:1 conduction
Comment: The computer interpretation was originally sinus rhythm, but upon closer inspection, two P-waves (arrows) can be seen for every QRS complex.
ECG 2
The patient’s dose of flecainide was increased, and diltiazem was also added for better rate control. She was then discharged from hospital, but then was back in the ER with dizziness. Her ECG is shown below:
ECG 2 Diagnosis
- Sinus bradycardia (P-waves noted with arrows) with sinus arrhythmia
- Competing junctional escape rhythm
ECG 3
The patient underwent pacemaker implantation. Post pacemaker ECG is shown below:
ECG 3 Diagnosis
- AV sequential pacing
- Intermittent fusion beats are noted (beats 1,3,5 and 7 are narrower than other beats because of a fusion between the paced beats and AV conduction that occurs after atrial pacing)
ECG ID: E823