Case 136: A 63-Year-Old Woman with a Prosthetic Aortic Valve
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
History
Six months ago, this 63-year-old man underwent replacement of his aortic valve for severe calcific aortic stenosis. He did well, and was symptom-free until one week ago when he started experiencing weakness, fatigue and dyspnea. He was seen in the cardiac clinic and admitted to the hospital:
Diagnosis
- Sinus rhythm with second degree AV block (2:1)
- Ventricular rate 32/min
- Rightward axis (computer-calculated frontal QRS axis = +91 degrees)
- Left ventricular hypertrophy with ST-T abnormality
ECG 2
Ten minutes later, a second ECG was recorded (at half standard sensitivity):
ECG 2 Diagnosis
- Sinus rhythm with Mobitz I second degree AV block
- Ventricular rate 35/min
- Rightward axis
- Left ventricular hypertrophy
ECG 3
A pacemaker was implanted, and the following ECG was recorded:
ECG 3 Diagnosis
- Dual chamber pacemaker
- Normal sinus rhythm, 60/min, with AV-sequential ventricular pacing
ECG ID: E260