Submitted by jer5150 on Sat, 08/04/2012 - 08:40
Patient's clinical data: 55-year-old white man on spinal cord ward.
To the computer's original statements (bottom 3 lines with grey background), the cardiology fellow free-hand texted the capitalized word in blue. He also added the diagnostic statement behind it (top line):
MARKED Sinus bradycardia with Sinus arrhythmia
Incomplete right bundle branch block
Nonspecific T wave abnormality
Abnormal ECG
DO YOU AGREE WITH THE COMPUTER AND/OR THE CARDIOLOGY FELLOW?
Questions:
(1.) What’s the most common cause of a sudden, unexpected pause?
(2.) Are the ventricular cycles waxing and waning here?
(3.) What’s the differential diagnosis?
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Comments
SA exit block
Looks to be a sinus rhythm, P waves upright in I and aVF. Mostly regular sinus rhythm at a rate slightly faster than 60 bpm. There appears to be incomplete right bundle branch block as well.
The pauses are two times the P-P interval, which leads me to believe the sinus node is firing, and the signal is not penetrating the atrial tissue. The next P comes on time, and conduction is normal.
This SA exit block could be caused by sick sinus syndrome, due to pathology or advanced age.
SA exit block
I agree with DaveB. This is 2:1 SA exit block.
INTERPRETATION
(1.) Sick sinus syndrome (SSS) manifest in the form of . . .
(2.) . . . sinus rhythm (discharge rate about 63/min) with . . .
(3.) . . . Type II sinoatrial (S-A) block; (see laddergram)
(4.) Incomplete right bundle-branch block.
Jason E. Roediger - Certified Cardiographic Technician (CCT)
[email protected]