75-year-old lady with history of hypothyroidism | MonitorTech.org
A 75-year-old lady with a history of hypothyroidism (HT) presents with a period of a brief loss of consciousness after getting up from a chair to answer the phone. She became dizzy and passed out for a few minutes. She denies palpitations, chest pain, or shortness of breath. Her blood pressure (BP) is 138/68 and fell to 118/68 upon standing. The 12-lead electrocardiogram (ECG) is as follows:
Question 1: The ECG shows
- A. Atrial fibrillation
- B. Normal sinus rhythm
- C. Left bundle branch block (LBBB) with first-degree heart block
- D. Ventricular tachycardia
Initial telemetry in the hospital was unremarkable. An event recorder was requested. The transmission is as follows:
Question (2) The above recording shows:
- A. Atrial fibrillation and flutter
- B. Ventricular standstill and torsades de pointes
- C. Supraventricular tachycardia (SVT) and right bundle branch block (RBBB)
- D. Junctional rhythm and aberrant conduction
The patient went into cardiac arrest, and after 6 minutes of cardiopulmonary resuscitation (CPR) and defibrillation, a return of spontaneous circulation was achieved. Blood electrolytes were normal. Below is a post-resuscitation ECG.
Answers and discussion
Question 1 Answer: Left bundle branch block (LBBB) with first-degree heart block
Question 2 Answer: Ventricular standstill and torsades de pointes
Ventricular standstill is an arrhythmia that is potentially fatal and often associated with syncope. Torsades de Pointes is polymorphic ventricular tachycardia that may terminate spontaneously or worsen into ventricular fibrillation.
Written by Judith Haluka on Dec 20, 2017
Last reviewed and updated by Caitlin Goodwin on Nov 9, 2021