ECG of the M onth
Unexpected Atrioventricular Conduction in High-Grade Atrioventricular Block
Manpreet Singh, MD; Paul A. LeLorier, MD; Murat M. Celebi, MD; D. Luke Glancy, MD
A 90-year-old man with a history of high blood pressure, a cerebrovascular accident without focal residua, dementia, and stage 3 chronic kidney disease went to the emergency department because of dizziness and near syncope. His medications were aspirin 81 mg qd, clopidogrel 75 mg qod, escitalopram oxalate 10 mg qd, quetiapine fumarate 25 mg qd, and memantine hydrochloride 10 mg qd. He had orthrostatic hypotension with supine blood pressure of 173/77 mmHg falling to 116/68 on standing, while pulse increased from 66 to 84 beats/min. He received IV fluid and returned home. Two days later, he sawhis primary care physician because of episodes of dizziness and confusion. The Figure shows an electrocardiogram recorded during that visit.
Figure 1: Outpatient electrocardiogram recorded in a 90-year-old man with episodes of dizziness and confusion. See text for explication.
What is your diagnosis? Explication is on pg. 28
J La State Med Soc VOL 166 March/April 2014 75
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