70 year old with syncope

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A 72 year old woman is brought to your Emergency Department after a syncopal episode

  • a. Describe and interpret her ECG (50%)
  • b. Outline your disposition considerations (50%)

Using the ‘ECG in 20 Seconds’ Approach:
Rate: 66
Rhythm: P waves present before each QRS
QRS: widened and RBBB pattern
Axis: Left axis
ST-T: Normal
PR/QT: Prolonged PR interval

This is a triphasicular block. A bit of a misnomer as only two fascicles are really blocked( left anterior and right bundle). The PR interval indicates disease however we are unclear as to where that disease is, is it in the Atrioventricular node or in the conduction system.

It explains the patient syncope. This patient needs a coronary care unit and cardiac monitoring. Electreophysiological studies may be done, however, patients presenting with syncope and this ECG, will get a pacemaker.

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Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.

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