ECG Case 6

Question 1

HPC: 35 year old male presents non-specific malaise cough and low grade fevers. Has had multiple courses of abx from his GP with no symptomatic benefit.

BG: Nil

O/E:
Obs: RR 18 , Sats 95%, BP 115/ 75, HR 52, Temp 37.8

CVS: Reg irreg pulse, good volume, normal character, HS I+II + systolic murmur (new)

Resp: Chest clear

Answer 1

-

Question 2

This is his ECG. What are the findings?

Answer 2

Mobitz type 1 (Wenkebach)

Question 3

what is the likely cause for this arrhythmia?

Answer 3

infective endocarditis with abscess formation

Question 4

what is the connection between the dx and the ECG findings?

Answer 4

abscess compressing on the AVN node causing heart block

Question 5

how would you manage this pt?

Answer 5

• sepsis 6
  
  • IV abx (amox / gent / vanc for native valves)
  • IV fluids
  • O2 (if required)
• cardiac monitoring
• referral to cardiothoracic surgeons for drainage