ECG Case 020

80-year old patient with palpitations and syncope. What does the ECG show?

TOP 100 ECG QUIZ LITFL 020

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!

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 |

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