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Case Report: Complete atrioventricular block in an elderly patient with acute pulmonary embolism

Frontiers in Cardiovascular Medicine

Introduction Multiple abnormal electrocardiographic findings have been documented in patients experiencing acute pulmonary embolism. To date, only a limited number of cases involving a complete atrioventricular block have been reported in acute pulmonary embolism. Echocardiography confirmed signs of right ventricular dysfunction.

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A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

You will note that it is essentially an unremarkable electrocardiogram except for some PACS. It is also not a wandering pacemaker — because change in atrial pacing site is gradual with that disorder. A majority of patients with MAT have longstanding pulmonary disease. I never see 2 P waves in a row with the same morphology.

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Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

MAT has at least 3 distinct P-wave morphologies, but there is no single dominant pacemaker (i.e., A deep neural network for 12-lead electrocardiogram interpretation outperforms a conventional algorithm, and its physician over-read, in the diagnosis of atrial fibrillation. IJC Heart and Vasculature 25(2019). Poon et al. GET a 12-lead!

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm. Family history of sudden death at age less than 40 — Negative predictors : —pacemaker, pre- or near- syncope only Workup (Smith opinion from literature) Always evaluate with: 1.