Squiggler

Two falls this week, no memory of hitting the ground

The case

74-year-old woman. Two falls this week, no memory of hitting the ground

HTN on amlodipine only. No known heart disease.

On arrival

SpO2
97% on air
Heart rate
42
Blood pressure
132/70

Stage 1 of 2

Two falls in 5 days, both standing, no prodrome, no memory of landing. Bruised forehead. Alert now, no chest pain. K+ 4.3, TSH normal.

Tracing 1 of 2 for the quiz “Two falls this week, no memory of hitting the ground”.
12-lead, 25 mm/s, 10 mm/mV Open this tracing in the studio
Rhythm?
Mobitz I or Mobitz II?
Which feature on this ECG most favours block below the AV node?

Stage 2 of 2

Admitted to monitored bed. Overnight telemetry strip.

Tracing 2 of 2 for the quiz “Two falls this week, no memory of hitting the ground”.
Lead II, 25 mm/s, 10 mm/mV Open this tracing in the studio

Observations

Heart rate
63
Blood pressure
128/68
Rhythm?
Management?

Diagnosis

Mobitz II AV block with bifascicular block (RBBB + LAFB), presenting as 2:1 block

References

  1. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-3520.
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Or, where scripts are stripped:

<iframe src="https://www.squiggler.io/blog/two-falls-this-week-no-memory-of-hitting-the-ground/embed" title="Two falls this week, no memory of hitting the ground — ECG case from Squiggler" width="100%" height="900" style="border:0" loading="lazy"></iframe>

This tracing was generated, not recorded. It opens in the studio with every dial live.

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Discussion

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