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Monday, 14 January 2013

#ECGclass Case 20

Welcome back to ECG Class and Happy New Year to everyone!
I hope you are all well rested and ready for another term.

For the benefit of newcomers:

#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! :-)

Case 20
I'm throwing you in the deep end a bit tonight, no New Year gradual warm up!  So don't be disheartened. It may look daunting at first glance, but bear with me, and you'll be surprised how easy it is to get on the right track, once you break the ECG down methodically!

It's Friday Morning and you are the duty GP. 
The CHD nurse has just done a 'routine' annual CHD review on a well 81yr old lady. As a matter of routine, she has done an ECG, and wanted to check you are happy with it before she lets the lady go home.

She puts the ECG below on your desk. 

Q1 Is there any other information you want?
           update info on next post

Q2 You now feel in a position to go an see the lady. What things might you want to know from her?
           update info on next post

Lets concentrate on the presenting (first) ECG above.

Q3  Is it regular, or irregular? Can you see P waves?
          update info on next post

Q3. So, what now?

This lady is 81yrs old. She's well. She's asymtomatic. 
Is Mobitz Type I, Second degree heart block benign? 
Do we need to do anything? 

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

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