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Monday, 28 January 2013

#ECGclass Case 22

#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 22

A 60yr old gentleman comes to see you with a persistently raised clinic blood pressure of 158/98 mmHg. You arrange Ambulatory BP monitoring (ABPM) which reveals a mean BP of 148/94 mmHg.

In accordance with the current NICE guidelines, you arrange bloods, urinalysis and ECG in order to assess any target organ damage. Cardiovascular examination is normal other than you notice a slight irregularity in his pulse. 

His bloods for FBC, TFT, U&E's, eGFR, glucose and lipid screen are all normal. 
He has no proteinuria. 
You calculate his 10yr cardiovascular risk to be 18%. 
His ECG trace is seen below. 

He denies any chest pains, dizziness or palpitations. In fact, he feels completely well. 

Q1. What does the ECG show?
Tip: Start with the P waves and ask yourself 3 questions :
Are they there? 
Are they consistent in morphology? 
Is the PR interval consistent and normal?

Q2. i) Does this ECG show LVH  ii) Are you going to offer BP medication?

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

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