History:
76 year old M with HTN, DM, HLD, Dementia BIBEMS via NH due to complaint of questionable syncope and possibly chest pain (poor historian even through speaking on Cyracom with him – ie Q: Have you ever had any surgeries? A: I worked in the circus and I always pay my taxes.”) Story we went with is he did not feel well and his chest hurt, called nurse, she called 911, when EMS came he states he passed out, Hypertensive, got ASA and Nitro and came to the hospital, no fall, was in bed the whole time. No fever, cough, nausea or diaphoresis. Was recently hospitalized with simiar complaint. Admitted to medicine for Syncope/ACS.
Official Resident Read:
Rate – between 4-5 large boxes – approx 62 bpm
Rhythm – sinus
Axis – Left axis
Intervals
PR – 6 boxes =240 ms
QRS – 4 boxes = 160 ms
QT – 410 ms
Complex Morphology – rSR – RBBB, LAFB because there is a Left axis with a RBBB (can argue for the finding rS in II,II, aVF)
ST Segments – no contiguous lead ST depressions or elevations
T wave Morphology – no TWI
Put it all together
Prolonged PR interval = First degree AV block
RBBB with Left axis = LAFB
Conclusion – Trifascicular Block
Thank you Dr. Bains for the EKG and congratulations to Dr. Terry!
mritchie
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