Case 154: A 61-Year-Old Man with Infective Endocarditis
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
History
This 61-year-old man is admitted with infective endocarditis of the mitral valve:
Diagnosis
- Atrial flutter
- Complete heart block with a wide-QRS escape rhythm (right bundle branch block pattern)
- Ventricular rate 54/min
When patients with atrial flutter develop third degree AV block, the arrhythmia may be wrongly diagnosed if the variation of the flutter wave-QRS interval is missed. In this case, the computer’s diagnosis was incorrect: “Atrial Flutter with variable AV block”. The escape pacemaker may be located in the AV junction (with right bundle branch block) or in the left ventricle.
ECG 2
Two days later the patient converted to sinus rhythm:
ECG 2 Diagnosis
- Sinus rhythm
- Third degree AV block with wide-QRS escape rhythm. Two premature wide-QRS complexes, with the same morphology as the escape rhythm.
ECG 3
Due to the patients complete heart block, a VVI pacemaker was implanted:
ECG ID: E218