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BACKGROUND
An 80-year-old man has a
preoperative ECG (see Image 1) performed before elective surgery. The
patient denied having any chest pain, palpitations, or a history of
arrhythmias, but he did report experiencing some shortness of breath
when he walked or performed chores around the house. The patient felt
that the shortness of breath was due to his "lung problems" from his
many years of smoking cigarettes. He also volunteered that he had
experienced brief episodes of lightheadedness but again denied having
any other associated symptoms, such as chest pain, nausea, presyncope,
and loss of consciousness. There is no history of myocardial infarction
or established history of coronary artery disease. As a result of the
reported symptoms and ECG findings, the patient was admitted to the
hospital for further evaluation.
Upon admission, the patient was found to be afebrile with a blood
pressure of 125/67 mm Hg, a heart rate of 84 bpm, a respiratory rate of
20 breaths per minute, and an oxygen saturation of 91% breathing room
air. He had a regular heart rhythm with frequent skipped beats and a
slightly accentuated second heart sound. No murmurs, rubs, or gallops
were appreciated. He had no jugular venous distention, and no carotid
bruits were noted. Auscultation of his chest revealed distant breaths
sounds without wheezes, crackles, or rhonchi. No peripheral edema was
present. The remainder of the examination was unremarkable.
What does the ECG demonstrate? |
Hint
Identify the P waves. |
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Authors:
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Ehab S. Kasasbeh, MD,
Resident, Department of Internal Medicine, James H. Quillen College of
Medicine, East Tennessee State University
Jonathan Burress, DO, Fellow, Division of Cardiology, James H. Quillen
College of Medicine, East Tennessee State University
Ryland P. Byrd, Jr, MD, Chief of Pulmonary Medicine, Medical Director of
Respiratory Therapy, Quillen Mountain Home Veterans Affairs Medical
Center; Professor, Department of Internal Medicine, Division of
Pulmonary Diseases and Critical Care Medicine, James H. Quillen College
of Medicine, East Tennessee State University |
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eMedicine Editors:
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Erik Schraga, MD, UCLA -
Olive View Medical Center Residency, Department of Emergency Medicine,
Olive View - UCLA Medical Center
Rick G. Kulkarni, MD, Assistant Professor, Yale School of Medicine,
Section of Emergency Medicine, Department of Surgery, Attending
Physician, Medical Director, Department of Emergency Services, Yale-New
Haven Hospital |
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