Case 20: A 58-Year-Old Man in the Cardiac Clinic
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
This 58-year-old man had a myocardial infarction 2 years ago. He has made a good recovery; he is active and symptom-free. Today, he presents to the cardiac clinic for reassessment:
Diagnosis
- Sinus rhythm, 69/mim
- Left bundle branch block (LBBB)
Compared with his ECG from six months ago, the LBBB is a new finding.
ECG 2
The patient returns to the cardiac clinic six months later. He reports occasional mild palpitations that he describes as “isolated pulsations”. He otherwise feels well and remains active. The following ECG is recorded:
ECG 2 Diagnosis
- Sinus rhythm, 79/min
- Frequent isolated premature ventricular complexes (PVCs)
- Left bundle branch block
The compensatory pause that follows the PVCs allows for the left bundle branch to recover and conduction to normalize. The diagnosis of a previous inferior myocardial infarction can therefore be made. This an example of acceleration-dependent aberration:
ECG ID: E721