ECG Case 020
80-year old patient with palpitations and syncope.
What does the ECG show?
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
Main Abnormalities
- Runs of tachycardia are interspersed with long sinus pauses (up to 6 seconds)
- The sinus rate is extremely slow, varying from 40 bpm down to around 10 bpm in places
- Sinus beats are followed by paroxysms of junctional tachycardia at around 140 bpm
Diagnosis
- This is a good example of sick sinus syndrome leading to the tachycardia-bradycardia syndrome
- The flurries of junctional tachycardia are a compensatory phenomenon attempting to maintain cardiac output in the face of critically low sinus node rates
- The syncope likely occurred due to a long sinus pause with temporary loss of cardiac output. This patient needs a pacemaker!
References
Further Reading
- Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
- Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
- Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
- Rawshani A. Clinical ECG Interpretation ECG Waves
- Smith SW. Dr Smith’s ECG blog.
- Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF
TOP 100 ECG Series
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |
MBBS FACEM DDU (Emergency) CCPU. Emergency Physician in Melbourne, Australia. Co-Ultrasound Lead for Emergency Medicine at The Alfred Hospital. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor of the LITFL ECG Library.
