McGill Case 28

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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.

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This is an electrocardiogram from an elderly man with a history of syncope. This electrocardiogram shows sinus rhythm at 74 per minute. The PR interval is grossly prolonged at 288 milliseconds, there's an R S R complex in V1 compatible with a right bundle branch block and a QRS axis of minus 83 degrees compatible with a left anterior hemi-block. Taking all three abnormalities together the tracing suggests a trifasicular block. This patient also had a Holter monitor that showed second-degree heart block and as a result a pacemaker was implanted because of his history of syncope.