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A 78-year-old man presents with dizziness for 3 days. This lasts for 30 s to 1 min; he does not feel palpitations and has no other cardiac symptoms.
Nine years ago, he was analysed for chest pain; exercise testing and echocardiography were normal. His further medical history reveals depression and hemi-colectomy because of colon carcinoma. Current medication consists of aspirin, lisinopril, simvastatin, lithium carbonate, nortrilen, pantozol, alprazolam and movicolon.
Physical examination revealed a slow regular pulse of 40 beats/min with a blood pressure of 110/60 mmHg, and investigation of heart and lungs was within normal limits. The ECG on admission is shown in Fig. 1. Laboratory examination showed a normal blood level of lithium and nortrilen. The echocardiography showed normal left ventricular function with a mild aortic stenosis.
ECG on admission (25 mm/s, 10 mm/mV)
What is your interpretation of the ECG? ■
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Reference
Levy MN, Zieske H. Mechanism of synchronization in isorhythmic dissociation. Circ Res. 1970;27:429–43.
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Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (https://creativecommons.org/licenses/by-nc/2.0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
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Erol-Yilmaz, A., Westra, S. & Smeets, J.L.R.M. Rhythm Puzzle. Neth Heart J 19, 95 (2011). https://doi.org/10.1007/s12471-010-0068-y
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DOI: https://doi.org/10.1007/s12471-010-0068-y