Case 78: A 77-Year-Old Man in the Coronary Care Unit History Diagnosis History A 77-year-old man is admitted to the coronary care unit: Diagnosis Marked junctional bradycardia, 37/min Acute septal infarction T wave abnormality, consider anterolateral ischemia ECG ID: E511
Case 79: A 65-Year-Old Woman in the Cardiac Clinic History Diagnosis History This 65-year-old woman with an eight-year history of coronary artery disease presents to the cardiac clinic for her annual assessment. She had an aortocoronary bypass surgery five years ago, and is free of angina. Her echocardiogram shows diffuse LV hypokinesis, with an ejection …
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Case 80: A 57-Year-Old Woman with Palpitations History Diagnosis History A 57-year-old woman presents with occasional palpitations that she describes a precordial pounding. She has good exercise tolerance, and no other complaints: Diagnosis Marked sinus arrhythmia (respiratory), 84/min Otherwise a normal ECG In sinus arrhythmia, there may be variations of the P wave morphology, probably …
Case 81: A 58-Year-Old Man with Paroxysmal Palpitations History Diagnosis ECG 2 ECG 2 Diagnosis History This 58-year-old man presented to the Emergency Department with a two year history of paroxysmal palpitations accompanied by dyspnea and weakness: Diagnosis Atrial flutter with variable AV conduction – ventricular rate 100/min Minimal criteria for left ventricular hypertrophy Typical …
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Case 82: A 52-Year-Old Man with Palpitations History Diagnosis ECG 2 ECG 2 Diagnosis History A 52-year-old man presents to the Emergency Department with severe palpitations, dyspnea, and presyncope for the past hour. He reports a thirty year history of episodic palpitations occurring once or twice annually and subsiding spontaneously. Otherwise, he is healthy and …
Case 83: A 36-Year-Old Man in the Cardiac Clinic History Diagnosis History This 36-year-old man with chronic renal failure treated with hemodialysis is followed in the cardiac clinic because of a bicuspid aortic valve with stenosis and regurgitation. One year ago, he was treated for a pulmonary embolism: Diagnosis Sinus rhythm, 78/min. Biatrial enlargement Left …
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Case 84: A 69-Year-Old Woman in the CCU History Diagnosis History A 69-year-old woman is admitted to the CCU with unstable angina: Diagnosis Accelerated junctional rhythm, 84/min Non-specific ST abnormality Comment: One can see retrograde P-waves which are the result of “backwards” activation over the AV node (the junction fires, and electrical activation goes back …
Case 85: A 66-Year-Old Woman in the Cardiac Surgery Unit History Diagnosis History A 66-year-old woman is postoperative day 4 from replacement of her aortic valve due to aortic stenosis: Diagnosis Accelerated junctional rhythm, 82/min Minimal criteria for left ventricular hypertrophy (S in V1 + R in V6 = 36 mm) ECG ID: E474
Case 86: A 45-Year-Old Man with No Fixed Address History Diagnosis History A 45-year-old man with no fixed address and no available medical records presents to the emergency department with a decreased level of consciousness: Diagnosis Junctional tachycardia, 119/min The relatively slower rate in this case helps to differentiate automatic junctional tachycardia from AV Nodal …
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Case 87: A 67-Year-Old Woman with Palpitations History Diagnosis ECG 2 ECG 2 Diagnosis History A 67-year-old woman presents to the Emergency Department with rapid regular palpitations for the past hour. She had similar episodes a few times a year since her early twenties, usually lasting from 30 minutes to 1-2 hours, and often relieved …
