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Solve The Case

A 70 yo woman presents to the emergency department with a 3 month history of intermittent dizziness.
Her only past medical history is hypertension, for which she is on an ACE inhibitor. There are no other medications and she has no allergies.
On arrival the patient's vitals are BP of 190/95, pulse rate of 48bpm and sats of 99% on room air. She is seen by the registrar.

Her examination is normal. Dual heart sounds, nil extra sounds, normal respiratory exam, abdomen is soft and the neurological exam is normal. She is stable on her feet and walks around the department with no assistance. 

Blood tests including FBC and UEC and Troponin are reported normal. The ECG is reported as normal.

The patient is to be discharged, when you review. What did the doctor miss?
Picture

Solution

To solve this case, we need to be suspicious as to why the patient has bradycardia, when they are not on a beta blocker.
The money is in the ECG. This is a MOBITZ II with a 2:1 Block
The problem with Mobitz II blocks like this is that they can deteriorate into a complete heart block.
​The patient had a pacemaker inserted.
Picture
In last week's EMQA we spoke about a 2:1 block where the p waves were hidden in the T waves. These are not hidden.
CAUSES OF MOBITZ BLOCKS
  • AMI
  • Hyperkalaemia
  • His-Purkinge System Failure below AVN
  • Conduction System Fubrosis
  • Drug related: Amiodarone, Beta blockers, Calcium Channel Blockers, Digoxin
  • Inflammatory/Autoimmune: Myocarditis, Rheumatic Fever, SLE
If you are a member of the Cardiac Bootcamp Self Study Course, go to the section on Mobitz Blocks and review.
Become a Cardiac Bootcamp Course Member today and become the Cardiac Expert
Join me for a face to face Cardiac Bootcamp on the gold Coast on the 19th January 2021

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  • Home
  • EMCORE CONFERENCES
    • EMCORE GOLD COAST LECTURE VIDEOS
    • EMCORE Sydney 2021
    • FAQ
    • CERTIFICATES >
      • Fiji 2019
      • Gold Coast certificates
    • Previous EMCORE's >
      • EMCORE Gold Coast 2020
      • Fiji 2019
      • Melbourne 2019
      • Hong Kong 2019
      • Byron Bay 2019
      • Santorini 2018
      • Fiji 2018
      • Melbourne 2018
      • Hong Kong 2018
      • Hong Kong 2017 >
        • EMCORE HONK KONG Certificates
        • EMCORE HONG KONG 2017 VIDEOS
      • Melbourne 2017 >
        • Video of the Week
      • Fiji 2016 Gallery >
        • Melbourne 2016 >
          • Pre-Conf Workshops >
            • Melbourne 2016
            • Cardiac Bootcamp
    • EMCORE Singapore 2020 POSTPONED
  • CARDIAC BOOTCAMP
    • CARDIAC BOOTCAMP
    • SELF STUDY COURSE
    • Cardiac Blog
  • EMCORE DIGITAL
  • STORE
  • MEMBERS
    • LOGIN