Male, aged 66 years.
🔸Presenting complaint :
Sensation of ‘missed heartbeats’.
🔸History of presenting complaint :
After retiring, and adopting a more sedentary lifestyle, the patient first became aware of something wrong when he was sitting quietly, reading the newspaper. He noticed that every now and then, his heart appeared to ‘miss a beat’. Although he still enjoyed his normal weekend walking and badminton, he was anxious in case the missed beats were a sign of heart disease, as his mother had recently died of a ‘massive heart attack’. He reported his concerns to his family doctor.
🔸Past medical history :
No significant medical history.
Pulse: 57/min, irregular (occasional ‘missed beats’).
Blood pressure: 144/94.
JVP: not elevated.
Heart sounds: normal.
Chest auscultation: unremarkable. No peripheral edema.
FBC: Hb 14.3, WCC 7.5, platelets 278.
U&E: Na 139, K 5.0, urea 5.1, creatinine 96. Chest X-ray: normal heart size, clear lung fields. Echocardiogram: normal.
1. What does this ECG show❓
2. What is the mechanism of this❓
3. What is the prognosis❓
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