Monday, 14 June 2010

A 58 year old women presents with episodes of "greying out" with exertion


Here's great case submitted by Dr John M

A 58 year old women presents with episodes of "greying out" with exertion. She has had a slightly higher than usual heart rate for a few days, but of late, any exertion brings on near syncopal episodes.

Past history includes long-standing atrial fibrillation. In the past two years, she has had two left atrial ablations. The first ablation included pulmonary vein isolation alone, but the second one, done 3 months prior included repeat pulmonary vein isolation, plus left a left atrial roof line, mitral isthmus line and multiple ablations of complex-fractionated electrograms.

Exam: She is an obese female, with a BMI of 38, BP 98/58, HR- 170, RR-24.
She appears anxious and slightly diaphoretic.
Neck veins not distended
Lungs are clear
Heart exam reveals tachycardia
No peripheral edema

The first ECG is here...




The nurse calls to tell me she has converted to Sinus Rhythm.  After looking at this second ECG, do you concur?



After a brief procedure later in the day, this ECG is recorded.