An 80-year-old woman, who had previously had a few attacks of dizziness, fell and broke her hip. She is found to have a slow pulse, and her ECG is shown below. The surgeons want to operate as soon as possible but the anesthetist is unhappy.
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What does the ECG show and what should be done?
The ECG shows:
• Complete heart block
• Ventricular rate 45/min
Clinical interpretation
In complete heart block there is no relationship between the P waves (here with a rate of 70/min)
and the QRS complexes.
The ventricular 'escape' rhythm has wide QRS complexes and abnormal T waves.
What to do
In the absence of a history suggesting a myocardial infarction, this woman almost certainly has chronic heart block: the fall may or may not have been due to a Stokes-Adams attack. She needs a
permanent pacemaker, ideally immediately to save the morbidity of first temporary, and then
permanent, pacemaker insertion. If permanent pacing is not possible immediately, a temporary
pacemaker will be needed pre-operatively.
Diagnosis: Complete (third degree) heart block.
What does the ECG show and what should be done?
The ECG shows:
• Complete heart block
• Ventricular rate 45/min
Clinical interpretation
In complete heart block there is no relationship between the P waves (here with a rate of 70/min)
and the QRS complexes.
The ventricular 'escape' rhythm has wide QRS complexes and abnormal T waves.
What to do
In the absence of a history suggesting a myocardial infarction, this woman almost certainly has chronic heart block: the fall may or may not have been due to a Stokes-Adams attack. She needs a
permanent pacemaker, ideally immediately to save the morbidity of first temporary, and then
permanent, pacemaker insertion. If permanent pacing is not possible immediately, a temporary
pacemaker will be needed pre-operatively.
Diagnosis: Complete (third degree) heart block.