mobey Posted June 4, 2009 Share Posted June 4, 2009 52 y/o male started having exertional fatigue/SOB 2 days ago. No diaphoresis, no N&V, no chest pain. PMHx: HTN x 10yrs, tonsillectomy 40+ yrs ago. Pt a retired phone company worker, did mostly home installs of internet stuff. Non smoker, non drinker. Appears appropriate for age. Family Hx: Father had MI at 51, sister also HTN at young age. Medication: Enalapril, ASA 81mg daily, Multivitamin. Pt in no distress. P38 radial R14 non laboured, Air entry clear bilat, BP 98/60, Temp 37.1, Skin - pale warm dry, Sp02 98% room air Link to comment Share on other sites More sharing options...
Kiwiology Posted June 4, 2009 Share Posted June 4, 2009 Strip looks like 3rd degree heart block and possibly a bundle branch blocks (rabbits ears QRS) His sats are good, BP is a wee bit low but I wouldn't be concerned about that, at the most I might put this pt. on O2 depending on how bad his shortness of breath/sats were/got (mainly for psychosematic effect). Link to comment Share on other sites More sharing options...
mobey Posted June 4, 2009 Author Share Posted June 4, 2009 Strip looks like 3rd degree heart block and possibly a bundle branch blocks (rabbits ears QRS) Have a peek at the lead II strip along the bottom again. The QRS complex's that are present do have an associated P wave. Definatly a block.... just not a 3rd degree Link to comment Share on other sites More sharing options...
chbare Posted June 4, 2009 Share Posted June 4, 2009 (edited) This is curious, and a great strip. It looks like a complete heart block. Look closely, you have P waves all over the place. P waves in the T waves, and even a P wave that blends into the QRS on the first complex of the lead II continuous strip. I think what may throw some people is the fact the QRS morphology changes. First, you have wide QRS complexes, and I suspect a ventricular escape rhythm, then the QRS complexes become narrow as the junction takes over. EDIT: Review the continuous lead II strip. My assessment at least. Take care, chbare. Edited June 4, 2009 by chbare Link to comment Share on other sites More sharing options...
Kiwiology Posted June 4, 2009 Share Posted June 4, 2009 My bad, Mobitz II Link to comment Share on other sites More sharing options...
mobey Posted June 4, 2009 Author Share Posted June 4, 2009 Thought I would add a strip of lead II off our LP12 Link to comment Share on other sites More sharing options...
chbare Posted June 4, 2009 Share Posted June 4, 2009 What was done first? The XII lead clearly begins as a complete heart block. The LP 12 strip looks like a second degree heart block Mobitz II. Looks like this guys conduction system could not make up it's mind. Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted June 4, 2009 Author Share Posted June 4, 2009 12 lead was 1st Link to comment Share on other sites More sharing options...
chbare Posted June 4, 2009 Share Posted June 4, 2009 Cool, you found him in a CHB, then actually caught the conversion to a Mobitz II? How did he do en-route? Do we know the rest of the story? Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted June 4, 2009 Author Share Posted June 4, 2009 Enroute he was as above. No real complaints but easily fatigued with mild exertion ie: stand and pivot to cot. My tx was limited to: I.V. TKO, and considered ASA.... still kinda thinkin I should have. Anywhoo.... As far as I know he was headed for a pacemaker. CK-MB & Troponin were negative, the cardiologist was thinking this was not MI induced. Link to comment Share on other sites More sharing options...
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