Case 40: A 50-Year-Old Man in the Cardiac Surgical Ward

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Practice Level 4

Case 40: A 50-Year-Old Man in the Cardiac Surgical Ward

History

Diagnosis

ECG 2

ECG 2 Diagnosis

History

A 50-year-old man is in the cardiac surgical ward two days after bypass surgery:

Diagnosis

Sinus tachycardia, 115/min, with complete heart block
Junctional escape rhythm, with incomplete right bundle branch block (iRBBB) pattern and nonspecific ST abnormality
Frequent premature ventricular complexes (that reset the escape junctional pacemaker)
Ventricular rate 61/min

Comments: A FREQUENTLY ASKED QUESTION: “why the interval between the two successive escape complexes is shorter than the interval between the PVCs and the following escape complexes? ANSWER: The stimulus from the PVC has to travel up to the AV node to discharge and reset it. This explains the longer interval”