Heart Transplant

Report:

Sinus rhythm 92/min

Another sinus rhythm, 66/min

Atrial ‘parasystole’

Small voltage

Comment:

This was, of course, a “trick question” - except that the answer should suggest itself without even looking at the trace. Not many types of surgery can be diagnosed from their postoperative ECGs! It is even easier than the first sentence of the NEJM CPCs.

The slower, recipient’s, P waves are not conducted, since they cannot negotiate the surgical suture line between the recipient’s and the donor’s atrium.

Interestingly, there is a slight but definite rate variation in the denervated heart.

Low voltage can be a sign of transplant rejection, but was not that (clinically) in this case.

Fig 97. 74 year old woman in cardiogenic shock.

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