McGill Case 181

This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia. Previous Case: McGill Case 180 | Next Case: McGill Case 182

The first tracing was recorded in the emergency room, and is from a 70 year old woman with two sycopal attacks. She was on metoprolol and diltiazem for angina {normal coronaries and an abnormal MIBI perfusion scan}.

This tracing was taken in the intensive care unit after a temporary pacing wire (soft semi-floater) was placed via the right internal jugular vein. The lead paced the ventricle well, but the patient immediately complained of moderate chest pain, better with sitting up.

This was an X-ray taken the day after the insertion of the temporary pacing lead. The patient continued to have chest pain.

This cardiogram was taken at the peak of the chest pain.