A 68 year old male is brought into the emergency department having been found collapsed at a bus stop. He was known to have a long history of hypertension for which he takes a thiazide diuretic with variable BP control. A previous ECG demonstrated left ventricular hypertrophy with 1st degree heart block of which he was asymptomatic. His wife reports that he had been complaining of strange intermittent thumping sensations in his chest over the preceding few weeks with dizzy episodes. On arrival to ED he is grey and sweaty but conscious and orientated. His observations are: HR 35 irregular BP 90/38 (Difficult to measure) RR 20 SpO2 94% What does his ECG show? How would you manage this patient?



Sinoatrial nodal block, escape rhythm, p pulmonale,narrow qrs complex ,st depression in lead 2 and 3 but not in lead 1 Suggest posterior mi, During posterior MI, SA and AV node are affected To manage this case urgent TPI was done followed by coronary angiography which shows proximal RCA was 100% occluded, which was recanalised and sinus rhythm was achieved, later on TPI was removed and patient was discharged on DAPT and Statins and supportive measures Big big Thanks everyone for participation and putting your interest towards discussion Yours valuable inputs are welcome

Very nice sir. Please keep it up . With many many thanks

Sinus arrest with junctional escape beat. There are tall P waves with ST depressions. What about electrolytes as the patient is on diuretic? If lytes are within normal range, then it's SSS.

Is it possible to get p wave after sinus arrest

Sick sinus syndrome Sinus arrest Needs permanent pacemaker implantation as definitive management Patient to be kept on temporary pacemaker support till then as he is symptomatic

Complete heart. Block,pt. Needs Holtar Monitoring & Cardiologist opinion for Permanent pacing if required so

Ischemia with CHB Antiplatelates ,Angiography with Urgent Pacing or PCI. SPO2 94 % ?? Treat hypotension

Atrial fibrillation As pt haemodynamically unstsble Immediate cardioversion Carotid msssage

To maintain BP within 129/89mmHg and PR with pace marker

CHB. Permanent pacemaker, till then temporary pacemaker.

Complete heart block... Need urgent pacemaker pacing


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