An 89-year-old woman presents with a history of hypertension and hyperlipidemia. She is admitted because of "an irregular heart beat" and difficulty with speech as noted by her family. An echocardiogram (ECG) shows left ventricular diastolic dysfunction and left atrial enlargement.
A 12 lead ECG was obtained (Figure 1).
Figure 1:
The ECG shows which of the following?
Show Answer
The correct answer is: E. B and C.
Junctional escape rhythm (B) and sinus beats conducted with ventricular aberration (C).
The ECG shows a junctional rhythm with intermittent sinus capture, some of which conduct to the ventricles (the second beat demonstrates a right intraventricular conduction delay, the third beat conducts normally with 1:1 AV conduction, and the seventh beat conducts with RBBB aberrancy.
Answer choice A is incorrect. The axis in the frontal plane is horizontal (approximately 0 degrees), and there is no left axis deviation.
Answer choice D is incorrect, as the second and seventh QRS complexes are not premature ventricular beats.
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