Case No. 4 D
A 59 yr old white male presented to his primary care physician with complaints of weakness and exertional dyspnea. The following ECG was recorded by EMS called to the scene.
Again we see the preference in RCA occlusion for a junctional rather than ventricular escape pacemaker. The low voltage baseline activity in leads I, II, and III appears artifactual, however a close examination of the precordial leads demonstrates a small blip consistantly 200ms after the beginning of the QRS, suggesting the possibility of retrograde atrial depolarization buried within the ST-segment. These findings have been marked with the red arrows below.
The disturbances marked with the blue arrows should also be noted, perhaps representing atrial depolarizations with “P-mitrale” morphology. Under this interpretation, the EKG in fact demonstrates a sinus rhythm with marked 1st degree block. Unfortunately, no additional tracings are available for study.
This pt survived to reach the cath lab, but no further is known.