Case 110: A 59-Year-Old Man in the Emergency Department

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Practice Level 5

Case 110: A 59-Year-Old Man in the Emergency Department

History

Diagnosis

History

This 59 year old man has been referred to the emergency department by his family physician because of episodes of faintness and weakness during the past several weeks and the abnormal ECG

Diagnosis

Sinus rhythm with 1st degree AV block
Frequent junctional premature beats (labeled PSVC)
Ventricular rate 91/min
Right bundle branch block
Left anterior fascicular block

Comment: The PR interval of the early beats is too short (compared with remainder) to have been conducted, and thus it is either a premature ventricular beat or premature junctional beat. Because the morphology of the premature beats is nearly identical to that of the conducted beats, the most likely diagnosis is a premature junctional beat.

ECG ID: E580

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