A 68-year old female came to JIPMER Hospital, Pondicherry, India with chief complaints of giddiness on and off since last 3 days along with dyspnoea on exertion NYHA II. Patient was a known case of hypertension and she was on beta blocker. ECG of the patient is shown below.
ECG 1(Click on the image to enlarge it)
ECG of the patient is showing bradycardia with heart rate around 50 beats per minute, normal axis, normal QRS duration, there are two P wave for every one QRS complex, PR interval is fixed, around 120 msec, so the ecg is suggestive of 2:1 AV block, it could be 2 nd degree Type 1 or Type II AV block. As the patient was on betablocker so the drug was stopped. Her ecg done after 2 days is shown below.
ECG after 2 days of stopping beta blocker
ECG is now showing 3:1 AV block, so the block had progressed instead of improving in spite of stopping beta blocker so it means this patient is having significant AV node diseases. In view of her ecg changes she was advised to undergone permanent pacemaker. Following this patient successfully underwent permanent pacemaker insertion (VVI).
Thank you.
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