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Monday, 4 March 2013

#ECGclass Case26

#ECGclass Case 26

A 39yrs man, comes to see you in surgery.

He's worried about a transient "fainting" episode he had after a couple of glasses of lager, whilst watching the football with friends last Saturday. It was late in the evening and he felt very relaxed when it happened.

He denies any excess alcohol intake, in fact he rarely drinks. He doesn't smoke and keeps fit and active. He has always enjoyed good health, with no cardiac history and he denies any chest pain - despite high levels of activity, playing football and squash on a regular basis.

Examination is entirely unremarkable, with normal BP and pulse.

Q1.  Any other questions you might ask?
Q2.  Are you going to investigate at all?

You establish no cardiac family history of note, (for either chest pain or arrhythmia). He can't tell you much about his father as he had died "in his sleep", in India, when your patient was only a small child.  No clear diagnosis was ever made but he doesn't think he's ever had heart problems before he died. 

Being an avid follower of #ECGclass, you don't want to be caught out by missing a long QT syndrome, so you decide to get an ECG:

Q3 Now what? Are you happy with the QT interval?
      Is there anything else of note?

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


  1. What a crazy QRS shape! Am really worried about aberrant conduction problem with high chance of VF and death. Would definitely send this ecg to hospital team for reporting at least.

  2. Brugada Syndrome, increased risk of sudden cardiac death. With the family history sounding very suspicious of SCD and a suggestion of syncope/pre-syncope this chap most definitely needs a referral to cardiology.