A 75-year-old woman was presented to our emergency department because her pulse had become slow during physiotherapy exercises. She had a history of bypass surgery for severe triple vessel disease and severe left ventricular dysfunction. Furthermore, one month before presentation, she had been hospitalised with progressive heart failure presumed to have been caused by a high ventricular rate during an episode of atrial fibrillation. In order to achieve rate control, she was treated with digoxin and bisoprolol. She recovered well from this episode of decompensated heart failure.
On presentation she had a two-day history of dizziness and light-headedness. On clinical examination her pulse rate was 30 bpm and blood pressure was 160/45 mm Hg. There were no clinical signs of heart failure or dehydration. The electrolyte panel was normal. However, her renal function worsened to an estimated MDRD-GFR of 22 ml/min compared with 37 ml/min one month earlier. The ECG at presentation is shown in Fig. 1.
Fig. 1
ECG at presentation
1.
What is your electrocardiographic diagnosis?
2.
What is the most likely mechanism?
×
Answer
You will find the answer elsewhere in this issue.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
