Left bundle, right diagnosis

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Ramachandra Barik

A 79-year-old male was brought to the emergency department by emergency medical services (EMS) with retrosternal chest pain radiating to both shoulders. The pain started 2 hours ago while he was working in his garden. His medical history included hypertension, hypercholesterolaemia and a transient ischaemic attack. Physical examination showed tachypnoea, 37 breaths per minute, without abnormalities at pulmonary or cardiac auscultation, a heart rate of 88 beats per minute, a blood pressure of 111/73 mm Hg and unremarkable findings on abdominal examination. However, the patient looked clammy and grey. Nitroglycerine (GNT) administered sublingually relieved the pain. A partial electrocardiogram was performed by an EMS nurse (Fig. 1). Which abnormalities raise your concern?

Saúde e medicina

Left bundle, right diagnosis
A. E. Schaafsma · C. Coolsma · H. Lameijer

What is your
diagnosis ?
https://link.springer.com/content/pdf/1
0.1007%2Fs12471-019-1255-0.pdf

Choose
A new left bundle branch block
B.The negative T wave in leads V5
and V6
C.The ST depression in leads V2–
V4
D.The irregularity of the cardiac
rhythm

Hints
https://link.springer.com/artic
le/10.1007/s12471-019-1256-
z

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1. Left bundle, right diagnosis A. E. Schaafsma · C. Coolsma · H. Lameijer

2. What is your diagnosis ? https://link.springer.com/content/pdf/1 0.1007%2Fs12471-019-1255-0.pdf

3. Choose A new left bundle branch block B.The negative T wave in leads V5 and V6 C.The ST depression in leads V2– V4 D.The irregularity of the cardiac rhythm

4. Hints https://link.springer.com/artic le/10.1007/s12471-019-1256- z

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