Rhythm Puzzle: An irregular rhythm at older age - Answer: Difference between revisions
Rhythm Puzzle: An irregular rhythm at older age - Answer (view source)
Revision as of 15:56, 29 September 2007
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m (New page: {{NHJ| |mainauthor= '''A.A.M. Wilde''' |edition= 2007:4,157 }} Figure|thumb An 86-year-old man presents in your outpatient clinic with stable angina pe...) |
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further prolonged (360 ms). Although atrial prematurity is generally followed by hampered AV-nodal conduction (i.e. this is normal AV-nodal physiology), a normal AV node should be expected to have recovered completely from previous conduction at these | further prolonged (360 ms). Although atrial prematurity is generally followed by hampered AV-nodal conduction (i.e. this is normal AV-nodal physiology), a normal AV node should be expected to have recovered completely from previous conduction at these | ||
long coupling intervals. Hence, and as also indicated by the baseline prolonged PR interval, his AV node is no longer functioning optimally. The β-blocker might of course be contributing to that. At the most right part of the ECG a long RR interval is seen. Again an atrial extrasystole is present which is now blocked. The coupling interval of this extrasystole is shorter than that of the first atrial extrasystole and is, not unexpectedly given the significantly hampered AV conduction of the first extrasystole, now | long coupling intervals. Hence, and as also indicated by the baseline prolonged PR interval, his AV node is no longer functioning optimally. The β-blocker might of course be contributing to that. At the most right part of the ECG a long RR interval is seen. Again an atrial extrasystole is present which is now blocked. The coupling interval of this extrasystole is shorter than that of the first atrial extrasystole and is, not unexpectedly given the significantly hampered AV conduction of the first extrasystole, now | ||
blocked. The PR interval of the following sinus beat is within normal limits, one more argument for a functional defect in a less than optimally functioning AV node. '''In summary: sinus rhythm with first-degree AV block, (blocked) atrial extrasystoles.''' | blocked. The PR interval of the following sinus beat is within normal limits, one more argument for a functional defect in a less than optimally functioning AV node. | ||
'''In summary: sinus rhythm with first-degree AV block, (blocked) atrial extrasystoles.''' | |||
