Shifting Atrial Pacemaker

Report:

Sinus rhythm

SVEB

Shifting atrial pacemaker

Right atrial abnormality

Right axis deviation + 130o

Left ventricular hypertrophy voltage

Possible biventricular hypertrophy

Nonspecific T wave changes

Comment:

Obviously, the shifting pacemaker was not this patient’s major problem. The shift was caused by an atrial ectopic, itself devoid of significance except for inducing the shift.

The biventricular hypertrophy was reported pretending not to have known the patient had a variant of single ventricle; the diagnosis is based on LVH with RAD. The huge 52 mm S wave in V2 may be due, in fact, to RVH as much as to LVH. In this case, it hardly matters.

There is an optical illusion here, due to overlap: some may see the V3 S wave as normal in size, and measure the V2 at 80 mm. It helps to have the trace without the rhythm strip in cases like this. But then, the shifting pacemaker would have been missed with shifting leads.

139. A Neurology outpatient with no cardiac history, sign or symptoms

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