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Monday, 12 November 2012

#ECG class - Case 15

#ECG class - Case 15

A usually fit and active, 30yr old man comes into see you complaining of intermittent dizzy spells over the past few weeks.

Examination of the cardiovascular system is normal. His pulse is strong, but you detect a slight irregularity. His BP is 108/72.
There is no significant family history of young heart disease, or sudden cardiac death.

However, he is visibly anxious, so you offer to do an ECG.

You get the following trace handed over from the new treatment room nurse:

What comments can you make?
Are there any other tests you want?

Please use the #ECGclass to post any questions/comments you'd like to make. 
Remember, everyone's opinion is valid, and most ECG's are open to debate/discussion. There are no wrong answers, just describe what you see. 

The first comment to make is that this isn't a 12 lead ECG and you may want to see the full 12 leads chest leads in order to interpret properly.
However, within the limitations of a 3 lead ECG, what comments can you make?

Is it regular? Or Irregular?
Are there any P waves?
If so, are the P all conducted? 
What about the QT interval?

You also request blood for FBC and Thyroid function, both of which are normal.
He is not on any medication, and has no significant past medical history.

On review, he still seems very anxious, and you ask him more specifically about his concerns.
He tells you he is worried about his heart and blood pressure, because he is under enormous pressure at work. He feels he is coping poorly with the unreasonable demands of his job, but he is under a lot of financial strain, and has no other work options.

See next blog for the full discussion on this case!