Case 111: A 63-Year-Old Man with Prosthetic Aortic Valve
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
A 63-year-old man, is presenting 6 months after replacement of aortic valve because of severe symptomatic aortic stenosis. After surgery he did well and was asymptomatic until one week ago, when he started complaining of tiredness, weakness, and dyspnea.
Note: ECG acquired at HALF STANDARD.
Diagnosis
- Sinus rhythm
- Second degree AV block (2:1 conduction) at beginning, then Mobitz I second degree AV block towards end
- Left ventricular hypertrophy with repolarization abnormality
ECG 2
Because of ongoing symptoms, a pacemaker is implanted:
ECG 2 Diagnosis
- DDD pacing
- Atrial sensed, ventricular paced rhythm
Comment: The paced QRS morphology is unusual in that lead I has an RSR’ pattern (usually positive) and the axis is inferior (usually superior). This is likely because the pacing lead is located in or close to the right ventricular outflow tract.
ECG ID: E259