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Discussion in 'Spot Diagnosis' started by protonmd, May 14, 2011.

  1. protonmd

    protonmd Well-Known Member

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    [​IMG]

    Study carefully the ECG, and propose a diagnosis.

    Thank you
     

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  2. Amiodarone

    Amiodarone Well-Known Member

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    RBBB + 3AVB
     

  3. protonmd

    protonmd Well-Known Member

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    I am posting the answer earlier than I am supposed to, since this a very hard ECG to diagnose and its purpose is educational and not to test you knowledge.

    And the answer is (I have created an edited image so that it is better understandable):

    [​IMG]

    Patients who have undergone heart transplant have the remaining atria from the "old" heart which beat separately from the new heart.

    The purpose of this quiz is to make notice that we have to study the ECG and not just to remember patterns that we look for each time.

    So if you look carefully you can see that there is always a P wave preceding the QRS complex, with a stable PR which is actually prolonged(1st degree AV block).
    You can also notice the other wave which is completely autonomous and if you think of the QRS complex and those P waves I mentioned above disappear you can see that this (remaining) wave has a stable frequency and that it has a morphology consistent with an atrial wave (P wave).

    Of course a situation where you will have to diagnose such an ECG is purely theoretical since most patients with heart transplant will mention it in their history :D
     

  4. kushal_samani

    kushal_samani Well-Known Member

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  5. Amiodarone

    Amiodarone Well-Known Member

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    but don't u think that there is RBBB (rsr' in V1, V2 and wide S in lead I)
     

  6. Rocket Queen

    Rocket Queen Super Moderator

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    I think the same.
     

  7. protonmd

    protonmd Well-Known Member

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    Yes there is RBBB, keep in mind that this is a transplanted heart which may have many conduction defects.
    I didn't mention it, since the purpose of this post is to show you how the ECG of a patient undergone heart transplant is usually like.
    The RBBB could be of significance if it is a new finding during the follow up of the patient.
     

  8. protonmd

    protonmd Well-Known Member

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