3. ID 168 78 year old woman with a heart murmur
Can you see P waves?
4. ID 168 – Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block
Yes, there is sinus rhythm, 77/min. The P-P interval varies in keeping with sinus arrhythmia
(a common normal finding) – Each P is followed by a QRS – The P-R is prolonged to 230 msec.
(1st
degree AV block)
5. ID 168 - Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block
There are no signs of right or left atrial enlargement
6. ID 168 - Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block
Let’s now look at the QRS complexes: There is normal QRS axis (between 0 and 90 degrees
7. The QRS duration is normal : There is no right bundle branch block, left bundle branch block or
non‐specific block
ID 168 - Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block
8. ID 168 - Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block –
Left ventricular hypertrophy with repolarization abnormality
There are findings of left ventricular hypertrophy with ST-T abnormality (“strain pattern”)
9. ID 168 Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block
Left ventricular hypertrophy with repolarization abnormality
There are no QRS changes of myocardial infarction
10. ID 168 Final diagnosis - Sinus rhythm, 77/min with sinus arrhythmia – First degree AV block
Left ventricular hypertrophy with repolarization abnormality