ECG Case 7

Question 1

A 72 year old patient presents to the receiving unit with collapse. He has been feeling dizzy for 2 days but has been having no other symptoms. His initial observations are: Pulse 38 BP 120/80 Sats 98% on air An ECG is awaited.

1. Name an initial bedside test you would check? (1 mark)

Answer 1

BM/capillary glucose

Question 2

2. He has an intravenous cannula inserted. Name three blood tests you would want to check giving a rationale for each. (3 marks)

Answer 2

1. FBC/Hb – May have anaemia
2. Mg+ - Can cause arrhythymias
3. Troponin – Ischaemia and ACS can cause collapse
4. U+Es/Potassium – Can cause rhythm disturbance
5. Calcium – Can cause rhythm disturbance
6. Glucose – Hypo can cause collapse

Question 3

3. He now has an ECG performed which is shown below. What is the diagnosis and name one other abnormality. (2 marks)

Answer 3

Compete/third degree heart block

1. Wide QRS
2. ST depression laterally
3. T wave inversion laterally

Question 4

4. What immediate treatment should he receive giving the route of administration? (1 mark)

Answer 4

Intravenous atropine

Question 5

5. This has no effect. He becomes more unwell 10 minutes later and his BP is now 70/40. Name three ways his condition could be treated (3 marks)

Answer 5

1. External pacing
2. Isoprenaline/adrenaline
3. Temporary pacing wire
4. Additional atropine