Sun31October0735PM 10

A 78-year-old man presents with episodes of syncope. His 12 lead ECG is as follows:

Which of the following is the correct diagnosis?

(Please select 1 option)

Complete heart block

Hypertropic cardiomyopathy Incorrect answer selected

Paced rhythm

Atrial fibrillation with left bundle branch block

Atrial fibrillation with complete heart block This is the correct answer

Explanation

Atrial fibrillation with complete heart block can easily be missed. Patients presenting in this rhythm require permanent pacemaker insertion.

Key features when interpreting this ECG include:

lack of P waves

regular ventricular rhythm, and

widened QRS complexes (indicating ventricular escape rhythm).

Atrial fibrillation with left bundle branch block is incorrect as the ventricular activity is regular on this ECG. In AF and LBBB one would expect irregularly irregular QRS complexes.

Complete heart block is incorrect due the absence of p waves.

Hypertropic cardiomyopathy is incorrect as there are no deep, narrow Q waves and no clear ST/T wave abnormalities (for example, giant T wave inversions in the precordial leads). HCM also often presents with left atrial enlargement on the ECG.

Paced rhythm is incorrect due to the absence of regular pacing spikes.

Answer Statistics

1

27%

2

14%

3

15%

4

25%

5

21%

Times answered: 289