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Monday, 17 September 2012

#ECGclass Quizz Case 10

#ECG Class is an educational blog which runs alongside Twitter.
A new ECG "quizz" is launched most Monday evenings, in term time. 
Cases are generally aimed at Primary Care. 
All scenarios are completely fictitious and theoretical, but based on commonly occurring presentations in General Practice. 
This is an educational site, intended for healthcare professionals and shouldn't be construed as patient advice. 

Please use the Hashtag #ECGclass on Twitter, if you want to ask the patient any questions, or request any further investigations. Alternatively, please join in discussion and leave comments below.

Remember there are no right or wrong answers!  

ECG interpretation is often open to debate, and will usually evolve and change as new information becomes available.  Everyone's opinion is valid, and useful for others, as the evolution process takes place. 
Together we will try and form an interpretation based on the trace, and information, we have in front of us. 
Don't worry if you disagree - shout up and share your thoughts - the diagnosis is often arguable on the basis of a 12 lead trace, and may only become more obvious when a longer rhythm strip is available. 

Please feel free to join in, but most important of all, have fun! :-)

#ECGclass  Case 10

This 49yr old man presents to his GP with a 6 month history of chest pain.
Sometimes this is triggered by exertion, sometimes at rest. It can be prolonged, often lasting several hours and on occasions, all weekend.

He considers himself fit and active, so he light-heartedly dismisses his symptoms. His job involves heavy labour, but he 'works through' his mild discomfort, which is very localised in the left upper chest, without radiation. He only came to see you, under duress, from his wife.
Other than this, he feels great.
He has no arm pain, no dizziness, and no breathlessness.

He is a non smoker, with no risk factors for IHD, and is not on any medication. His BP is normal, as always. However, you do hear a systolic heart murmur at the left sternal edge.

You obtain an ECG below:

What now?

He's sitting in front of you, feeling 'great' and looking clinically well.  At the time of his consultation/ECG, he is pain free, but he admits the pains can come and go several times a day.

When you've had a go,  you'll find the full discussion on the next blog!

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