Emergency Cases Northwest Group

074 Regular Patient

Situation

AF patient was in CHB.

Background

An elderly was admitted with a UTI. She was known to have AF, on digoxin [serum digoxin level was not toxic]. ECG showed a slow [40 bpm] regular rhythm, like this:

Ref: https://ecglibrary.com/af_chb.html

After several days of observation she was sent for PPM.

Assessment

This was complete heart block, even though there were no dissociated P-waves. The complexes were caused by a junctional or ventricular escape rhythm, which is regular.

Recommendation

If a patient known to have AF inexplicably now has a slow regularised rhythm, that isn’t sinus, consider that is could be CHB. In this situation you may not see the classic dissociated P-waves just a slow regular rhythm



PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group