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Diagnostic dilemma
Diagnostic Dilemma Prepared by G. Thomas Evans, MD In those issues in which our regular Case of the Month does not appear, The Green Journal will present a Diagnostic Dilemma—an electrocardiogram and/or radiograph with a brief case history—for our readers to solve. The correct answer appears on p. 262 of this issue.
If you would like to contribute a Diagnostic Dilemma, please submit a high-quality copy of the EKG or radiograph with a brief synopsis (⬍250 words) of the case to the AJM editorial office. Am J Med. 2000;108:256. 䉷2000 by Excerpta Medica, Inc.
CASE PRESENTATION
The top panel shows the ECG taken at 13:32, when the patient left the cardiac catheterization laboratory.
A 77-year-old woman presented to the emergency department in cardiogenic shock, accompanied by third degree A-V block with a junctional escape rhythm (see ECG). The data acquired by the ECG machine on the specified dates and times are displayed as a single complex representing 10 seconds averaged for each lead. The bottom panel shows the admission ECG from 09:59, and the middle panel shows right-sided chest leads taken at 10:01.
256
䉷2000 by Excerpta Medica, Inc. All rights reserved.
Questions 1. Considering the data in the bottom and middle panels, what is the “culprit” artery and at what location is it occluded? 2. What findings in the bottom and middle panels are associated with adverse outcomes? 3. Why was there an axis shift between the ECGs in the bottom and the top panels?
0002-9343/00/$–see front matter PII S0002-9343(99)00156-4
If you would like to contribute a Diagnostic Dilemma, please submit a high-quality copy of the EKG or radiograph with a brief synopsis (⬍250 words) of the case to the AJM editorial office. Am J Med. 2000;108:256. 䉷2000 by Excerpta Medica, Inc.
CASE PRESENTATION
The top panel shows the ECG taken at 13:32, when the patient left the cardiac catheterization laboratory.
A 77-year-old woman presented to the emergency department in cardiogenic shock, accompanied by third degree A-V block with a junctional escape rhythm (see ECG). The data acquired by the ECG machine on the specified dates and times are displayed as a single complex representing 10 seconds averaged for each lead. The bottom panel shows the admission ECG from 09:59, and the middle panel shows right-sided chest leads taken at 10:01.
256
䉷2000 by Excerpta Medica, Inc. All rights reserved.
Questions 1. Considering the data in the bottom and middle panels, what is the “culprit” artery and at what location is it occluded? 2. What findings in the bottom and middle panels are associated with adverse outcomes? 3. Why was there an axis shift between the ECGs in the bottom and the top panels?
0002-9343/00/$–see front matter PII S0002-9343(99)00156-4