ECG EXAMPLE #9
SCROLL DOWN FOR INTERPRETATION AND HISTORY
|
|
|
ECG #9 (continuous rhythm strips)
The patient was a previously fit 69 year old male with a recent onset some three weeks previously of shingles involving dermatomes over the left upper chest, associated with a dramatic decrease in exercise tolerance, accompanied by increasing malaise, and tachycardia and lightheadedness on exertion. Holter monitoring was performed after a 12-lead ECG had shown atrial flutter with 2:1 AV block. At around 0828 hrs the patient experienced shortness of breath at rest and lightheadedness accompanied by anxiety.
The ECG showed a regular tachycardia with a peak HR of 269 bpm. Atrial flutter was confirmed when occasional 'dropped beats' were seen; subsequently Wenckebach occurred with 5:4, 4:3 and 3:2 AV conduction causing HR to drop to 206 bpm. The patient was subsequently cardioverted to sinus rhythm and radiofrequency ablation was successfully performed.
Varicella zoster infections are not necessarily benign and have been associated with myocarditis complicated by life-threatening arrhythmias and cardiac failure, as well as pericarditis. Other serious non-cardiac complications include post-herpetic neuralgia, meningoencephalitis, cerebellitis, facial palsy, deafness (Ramsay Hunt Syndrome) and unilateral blindness. The lifetime risk of developing zoster is 20% to 30%, most commonly affecting older individuals.
The patient was a previously fit 69 year old male with a recent onset some three weeks previously of shingles involving dermatomes over the left upper chest, associated with a dramatic decrease in exercise tolerance, accompanied by increasing malaise, and tachycardia and lightheadedness on exertion. Holter monitoring was performed after a 12-lead ECG had shown atrial flutter with 2:1 AV block. At around 0828 hrs the patient experienced shortness of breath at rest and lightheadedness accompanied by anxiety.
The ECG showed a regular tachycardia with a peak HR of 269 bpm. Atrial flutter was confirmed when occasional 'dropped beats' were seen; subsequently Wenckebach occurred with 5:4, 4:3 and 3:2 AV conduction causing HR to drop to 206 bpm. The patient was subsequently cardioverted to sinus rhythm and radiofrequency ablation was successfully performed.
Varicella zoster infections are not necessarily benign and have been associated with myocarditis complicated by life-threatening arrhythmias and cardiac failure, as well as pericarditis. Other serious non-cardiac complications include post-herpetic neuralgia, meningoencephalitis, cerebellitis, facial palsy, deafness (Ramsay Hunt Syndrome) and unilateral blindness. The lifetime risk of developing zoster is 20% to 30%, most commonly affecting older individuals.