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Monday, 25 February 2013

#ECGclass Case 25

#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, 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! :-)

After last weeks scary paramedic pre- and post-shock rhythm, we're safely back behind the desk, in GP-land tonight:

#ECGclass case 25.

A 72yr old lady comes to see you complaining of mild fatigue, and occasional shortness of breath. She finds her house-work a little more tiring than she used too. She laughs as she tells you that her family say she just  "does too much" and "doesn't recognise that she needs to slow down".  She thinks they may be right, but just wanted your opinion and a check up.

She denies any chest discomfort during these episodes.
She has no past history of, or risk factors for, IHD other than her long standing hypertension.

Her BP has been well controlled for many years on Atenolol 50mg.  On the basis of more recent evidence, and hypertension guidelines, you discussed with her the pros and cons of changing this at her last medication review, but she was keen not to 'meddle', as it suited her well.

Respiratory and Cardiovascular examination are normal.
In particular, she has no creps, no ankle swelling, and no murmurs.
She is of slim build and looks clinically well.

You decide to check her ECG and BNP.
Other bloods (including FBC, U&E's, eGFR and TFTs) were all done within the last 3months and were all normal.

Her BNP comes back at 56 pg/ml and her ECG is below:

Q1.  What do you think of the machine analysis "Normal Sinus Rhythm"?
Q2.  What do you think of the machine analysis "Anteroseptal infarct, probably old" ?
Q3.  Is there any voltage criteria LVH? 

Q4.  What is the PR interval?
Q5.  What action might you take next?

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

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