This ECG is probably not for the basic ECG interpretation class.  But, it presents a challenge for the experienced ECG Gurus and instructors out there.  We will leave it here for one week, to allow for comments.  On June 22, we will publish Dr. Jerry Jones’s comments. 

The Patient      This ECG is from a 44-year-old man. He was stricken with Guillain-Barre’ Syndrome when he was 32.  He doesn’t know what his ECGs showed when he was hospitalized with GBS. He knows of no abnormal lab results except for a high CK of 414, attributed to the muscle wasting with GBS.

When he was 43, he started having occasional light-headedness, and was found to have bradycardia around 50 bpm that did not increase with exercise.  A loop recording showed occasional bradycardia over the next several years.  This ECG is now five years old, and the patient says he no longer suffers from bradycardia or lightheadedness, only occasional palpitations and a sensation of “skipped beats”. He lives an active life, albeit with some residual lower extremity weakness from the GBS.

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