McGill Case 66

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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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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.