Case 38: A 42-Year-Old Man with Fatigue and Weakness
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
A 42-year-old man presents to the Emergency Department with severe weakness and presyncope. He reports that four months ago, he started to notice fatigue on mild exertion. Previous ECG and Holter monitoring had shown sinus bradycardia at rest, limited increase of heart rate during moderate exercise, and occasional sinus pauses (up to 2.9 seconds) during sleep. His symptoms have been worsening over the past week:
Diagnosis
- Marked sinus bradycardia, with sinus arrhythmia
- Escape junctional rhythm, 32/min (AV dissociation). The last P is conducted (AV capture)
- Low QRS voltage
- Non-specific ST abnormality
ECG 2
A diagnosis of sick sinus syndrome is made, and the patient is referred for pacemaker implantation:
ECG 2 Diagnosis
- Electronic atrial pacemaker – paced atrial rhythm, rate 62/min
- Normal AV conduction
Initially an atrial pacemaker was implanted, however, when the atrial rate increased to 110/min, type I AV block at the level of the AV node occurred. Therefore, the patient received a dual chamber DDD AV sequential pacemaker with good functional results.
ECG ID: E655