A 79-year-old male presented with obesity, hypertension, type 2 diabetes mellitus, ischemic heart disease, AF, chronic obstructive pulmonary disease (COPD) and sleep apnea syndrome.
She came to the Primary Care clinic for dizziness with sensation of spinning objects, especially when lying down.
cough increased
She had no loss of consciousness, chest pain, vomiting or cold sweating.
Usually, the patient is treated with amyloidosis, repaglinide, nitroglycerin (parches), acenocoumarol, atorvastatin, atenthelinide, acetylcholine, isophanesome,
Physical examination revealed the presence of arrhythmia on cardiac auscultation, with slow, extinguished, and no murmurs.
Radial pulses are present and symmetrical.
Pulmonary auscultation revealed generalized hypoventilation, without excessive sounds.
The neurological examination is rigorously normal.
She had edema with fovea on her knees and signs of chronic venous insufficiency in her lower limbs.
With pulse oximeter we detected a heart rate of 30 beats per minute (lpm) and oxygen saturation of 90 %.
Patient's clinical features (mare with sensation of spinning objects without other added symptoms) and heart rate detected was decided to perform ECG.
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After assessing the ECG, and given the patient's personal history (HTN, ischemic heart disease), we compared the recording obtained with a previous ECG, performed three years ago during hospitalization for an episode of exacerbation of COPD.
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When comparing both recordings to the hospital electrodes, it was found that bradycardia did not appear and that the QRS complexes now seem rhythmic, but P waves were not observed, so the patient was clinically diagnosed.
With the suspected diagnosis of slow AF, negative chronotrope treatment is withdrawn, without improvement.
Given the lack of response to this measure, admission to Cardiology was decided.
After a complete study, the definitive diagnosis of AF with advanced atrioventricular block and grade III right bundle branch block was reached, which led to the decision of permanent symptomatic implantation.
The patient evolved favorably: the symptoms disappeared and the heart rate was controlled.
