Sinus Arrhythmias

Case 1 answer

Sinus Arrhythmia

History:
This ECG was recorded from a 79 year-old lady who presented to A&E with acute onset SOB and chest pain. PMedHx-IHD, hypertension, CHF. An systolic murmur was heard on examination.

ECG shows:

  • Sinus arrhythmia, rate ~75/min
  • -1° heart block, Normal axis, QRS duration, QT for rate.
  • Deep Q waves in III, aVF and V1-4, ? previous inferior and anterior MI
  • LVH by voltage criteria, LV strain pattern (Non specific ST depression in lateral leads)

    This lady has severe aortic stenosis (Gradient 35mmHg, LVEF-40%), her CHF was difficult to treat despite using maximum dose of frusemide. She refused to have an aortic valve replacement, with this degree of aortic stenosis her future prognosis is poor.

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