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A 75 year old male is brought to the emergency department because he was feeling faint this morning. They report that he is bradycardic with a blood pressure of 95/60. He is afebrile, and has a GCS of 15. You are shown his ECG. Please diagnose.

ECG in 20 seconds approach

Using ECG in 20 seconds approach, we assume an arrhythmia.

Is it sinus? There are P waves, inverted in aVR and upright in II, however no relationship between the p’s and QRS’s, ie there dissociation. Here is the diagnosis 3rd degree block.
QRS: There is right bundle branch block.
Axis: Left axis – so a biphasicular block
ST-T: There is T wave inversion and characteristics of hypertrophy
PR/QT: PR is long in some cases as dissociated and QT is normal.
This is a 3rd degree AV block. The patient needs a pacemaker.

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