Here’s an interesting case submitted by Alex Kroeze. He is currently taking a sabbatical from blogging but was kind enough to share this interesting case with me.
Here is the story in Alex’s own words.
78 year old male with a history of MI with cardiac arrest around 1975 as well as diabetes (metformin) and fairly well controlled hypertension. He had no history of dysrhythmia as best as I could determine. This gentleman had a sudden onset at rest at approximately 0900 this day of 2/10 chest heaviness with no radiation/provoke/palliate and it is constant in nature. When he told his wife, she felt his pulse and noted it to be extremely rapid. She wanted to call EMS immediately however he was resistant to this; eventually she decided to call us anyway even though he still didn’t want to.
On arrival he appears in no acute distress. He is calm with no shortness of breath, nausea, or other stated complaints beyond the heaviness. His lungs are clear apices to bases. He has a noticeably variable ‘loudness’ to the S1 heart tone. His apical heart rate is measured to be 180 beats per minute and he has a good strong radial pulse. No Cannon A waves noted on quick inspection. He is placed on the stretcher and oxygen is applied while vital signs and ECG are acquired (see attached files).
What is your interpretation of the ECGs?