ECG Case: 88-year-old Man with Syncope

00:01 Let's look at a case of an example of a patient who has -- is having some heart block.

00:05 So, here's the history: we see an 88-year-old man. He suddenly faints while eating dinner.

00:11 He's immediately attended by a nearby nurse, ambulance comes and gets him, brings him to the hospital where his blood pressure is 88/40 mmHg quite low, and his heart rate is 36/min, also quite low.

00:22 One of the critical factors here in this case, first of all, is a syncope episode.

00:26 He faints. Secondly, he's hypotensive. Third, he's bradycardic, very slow.

00:32 So here's the ECG. Think about this and make -- come up with a diagnosis.

00:45 If you came up with a diagnosis of complete heart block, you would be right.

00:50 How would we know that? Markedly slow heart rate, a wide QRS because of the subsidiary slow pacemaker in the ventricle, no regular relationship between the P waves and the QRSs.

01:02 If you plot that out, you'll see the P waves are occurring at a faster rate than the ventricle and they're occurring randomly in relationship to the QRS.

01:12 So, the diagnosis: complete or third-degree heart block.

01:17 Treatment is a permanent pacemaker restoring the normal heart rate, restoring the normal blood pressure, and people go on and live many years with the permanent pacemakers.

01:28 Thanks very much for being with me for this lecture. Please stay tuned for the next one.