Case 1

This case was provided by Mark Santamaria

Stem: Past history of hypertension and hyperlipidaemia. Patient presents with dyspnoea. Medications include a beta adrenergic blocker

+ List the significant findings in the ECG

  • The rhythm is irregular, and the ventricular rate is 60 - 80 beats per minute
  • There is (borderline) left axis deviation
  • Small Q waves are seen in Lead 1 and Lead aVL
  • If we look at the 2nd to 7th QRS complexes in the rhythm strip, we see that each QRS complex is preceded by a P wave. The PR interval increases from 0.28 seconds (for the second QRS complex) to 0.40 seconds (for the seventh QRS complex). A non-conducted P wave is seen after the T wave of the seventh QRS complex. The next (eighth to eleventh) QRS complexes are all preceded by a P wave, with a progressively increasing PR interval

+ Provide the most likely or important diagnosis

  • The underlying rhythm is sinus rhythm with Type I (Wenckebach) second degree heart block
  • Relevant normal observations: The QRS width is normal, and the transition zone is in Lead V4. There are no abnormalities in the ST-T segments. The QT interval is normal