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.
00:32
So here's the ECG. Think about this and make -- come up with a diagnosis.
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.
Which ECG changes are indicative of third-degree heart block?
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Dr. Joseph Alpert explains clearly what us, students, always miss by ourselves. Really great series of lectures!!!