# ECG Case: 88-year-old Man with Syncope

by Joseph Alpert, MD

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00:01 Let's look at a case of an example of a patient who has -- is having some heart block.

00:05 So, here's the history: we see an 88-year-old man. He suddenly faints while eating dinner.

00:11 He's immediately attended by a nearby nurse, ambulance comes and gets him, brings him to the hospital where his blood pressure is 88/40 mmHg quite low, and his heart rate is 36/min, also quite low.

00:22 One of the critical factors here in this case, first of all, is a syncope episode.

00:26 He faints. Secondly, he's hypotensive. Third, he's bradycardic, very slow.

00:45 If you came up with a diagnosis of complete heart block, you would be right.

00:50 How would we know that? Markedly slow heart rate, a wide QRS because of the subsidiary slow pacemaker in the ventricle, no regular relationship between the P waves and the QRSs.

01:02 If you plot that out, you'll see the P waves are occurring at a faster rate than the ventricle and they're occurring randomly in relationship to the QRS.

01:12 So, the diagnosis: complete or third-degree heart block.

01:17 Treatment is a permanent pacemaker restoring the normal heart rate, restoring the normal blood pressure, and people go on and live many years with the permanent pacemakers.

01:28 Thanks very much for being with me for this lecture. Please stay tuned for the next one.

The lecture ECG Case: 88-year-old Man with Syncope by Joseph Alpert, MD is from the course Electrocardiogram (ECG) Interpretation.

### Included Quiz Questions

1. No regular relationship between the P waves and QRS complexes
2. Progressively longer PR interval with intermittent dropped beats
3. Bradycardia with dropped beats that are not preceded by changes in the length of the PR interval
4. Consistent PR interval of > 200 ms
5. Abnormally slow accessory conduction pathway from the atria to ventricles

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