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Case 119: A 59 Year-Old Man in the Cardiac Catheterization Laboratory

Practice Level 5

Case 119: A 59 Year-Old Man in the Cardiac Catheterization Laboratory History Diagnosis History A 59 year-old man with intermittent chest pain and positive enzymes was brought to the cardiac catheterization laboratory for coronary angiography.  Prior to the procedure, the following ECG was recorded: Diagnosis Atrial Flutter with 2:1 Conduction Possible anterior myocardial infarction (poor …

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Case 121: An 87 Year-Old Pacemaker Patient in the Emergency Room

Practice Level 5

Case 121: An 87 Year-Old Pacemaker Patient in the Emergency Room History Diagnosis History An 87 year-old woman with a pacemaker presents to the emergency room with intermittent palpitations. Her ECG is shown below: Diagnosis Atrial paced rhythm, 60/min Premature atrial complexes Prolonged AV conduction (atrial pacing to native QRS time of 224ms) Intermittent ventricular …

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Case 122: A 77 Year-Old Woman in the Emergency Room with Dizziness

Practice Level 5

Case 122: A 77 Year-Old Woman in the Emergency Room with Dizziness History Diagnosis History A 77 year-old woman is seen in the emergency room with several days of dizziness. Her ECG recorded in the emergency room is shown below: Diagnosis Ectopic Atrial Bradycardia, 37/min AV Dissociation with Junctional Escape, 43/min Conducted P-waves have 1st …

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Case 123: A 71 Year-Old Man Admitted to Cardiology with Dizziness

Practice Level 5

Case 123: A 71 Year-Old Man Admitted to Cardiology with Dizziness History Diagnosis History A 71 year-old man was admitted to the cardiology ward with a one week history of dizziness.  The ECG below was recorded on the second day of his hospital admission: Diagnosis Sinus rhythm with sinus arrhythmia, 75/min; Ventricular rate 39/min Second …

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Case 2: A 56 Year-Old Man in the Defibrillator Clinic

Practice Level 6

Case 2: A 56 Year-Old Man in the Defibrillator Clinic History Diagnosis ECG 2 ECG 2 Diagnosis History This 56 year-old man with remote myocardial infarction and history of ventricular tachycardia presents to the implantable cardioverter defibrillator (ICD) clinic with a recent shock from his device. One of the electrograms from device interrogation is shown …

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Case 3: An 82 Year-Old Man in the Pacemaker Clinic

Practice Level 6

Case 3: An 82 Year-Old Man in the Pacemaker Clinic History Diagnosis History An 82 year-old man presents to the pacemaker clinic.  He is asymptomatic, and is 98% atrially paced upon interrogation.  His interrogation shows several episodes of tachycardia as noted below: Diagnosis Pacemaker Mediated Tachycardia (PMT) Comment: At the outset, this tachycardia is close …

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Case 4: An 87 Year-Old Man in Pacemaker Clinic for Routine Assessment

Practice Level 6

Case 4: An 82 Year-Old Man in Pacemaker Clinic for Routine Assessment History Diagnosis ECG 2 ECG 2 Diagnosis History An 87 year-old man presents to the pacemaker clinic for routine assessment and is noted to have several episodes of tachycardia.  On questioning, he has been completely asymptomatic.  One of the episodes of tachycardia are …

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Case 5: A 78 Year-Old Man in the Defibrillator Clinic

Practice Level 6

Case 5: A 78 Year-Old Man in the Defibrillator Clinic History Diagnosis History A 78 year old man with a primary prevention implanted defibrillator (ICD) presents to the defibrillator clinic for routine follow-up.  His interrogation reveals an episode which is shown below: Diagnosis Sinus tachycardia, 135/min Inappropriate Anti-tachycardia Pacing Comment: Note that during sinus tachycardia …

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