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This post is an interpretation of the ECG Case 198

• Rate:
  • Atrial Rate 83 bpm
  • Ventricular Rate 42 bpm
• Rhythm:
  • Regular
  • No relationship between P waves and QRS complexes

• Axis:
  • Normal (~65 deg)
• Intervals:
  • PR – No relationship
  • QRS – Normal (80ms)
  • QT – 440ms (QTc Bazette ~ 390 ms)
• Segments:
  • Apparent ST elevation in V3 although likely to be secondary to p wave superimposition

Interpretation

Complete heart block with junctional escape rhythm.

Differential Diagnosis

• Ischaemia
• Medications
  • Cardiotoxic agents
    • Therapeutic
    • Delibrate Self Harm
• Electrolye / Acid-base disturbance
• Aortic Valve Disease
• Congenital Cardiac Disease – Valvular or EP disturbance
• Sarcoidosis
• Myocarditis
• Thyroid Dysfunction – Hyper- or hypo-

What happened to this patient ?

• Stress Echo – Nil evidence of ischaemia with normal LVEF
• Cardiac MRI – Normal
• PET Scan – Normal
• Nil reversible / correctable cause found for CHB
• Dual chamber PPM Implanted (MRI Compatible)

READ MORE about Conduction Blocks at the AV Node (AV Blocks) [With Examples]

SIMILAR CASE: Complete (third degree) Heart Block in 80-year-old woman