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Challenges in Clinical Electrocardiography
May 9, 2022
LaszloLittmann,MD, PhD1
Author Affiliations Article Information
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1Department of Internal Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
JAMA Intern Med. 2022;182(7):770-771. doi:10.1001/jamainternmed.2022.1558
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LaszloLittmann,MD, PhD
JAMA Internal Medicine
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Mazen M.Kawji,MD
JAMA Internal Medicine
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A patient in their 60s presented with a several-day history of dizziness and light-headedness occurring during physical activity, including 2 episodes of loss of consciousness while running a short distance. Antihypertensive medications included daily lisinopril, 40 mg, and atenolol, 50 mg. On physical examination, the heart rate fluctuated from approximately 35 to 70 beats per minute (bpm), and after the patient moved from a prone to a sitting position several times, it decelerated rather than accelerating. Cardiovascular examination and routine laboratory findings were otherwise normal. Results of an electrocardiogram (ECG) on presentation revealed sinus rhythm of 66 bpm, PR interval of 180 milliseconds, and QRS duration of 118 milliseconds; QRS axis and morphologic findings were normal, with no ST-T abnormalities. The computerized interpretation software correctly indicated normal sinus rhythm. Because of symptomatic bradycardia, the β-blocker (atenolol) was withheld. A repeat ECG after 36 hours was interpreted by the software as sinus bradycardia at 52 bpm and otherwise normal (Figure, A).
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Cardiology Challenges in Clinical Electrocardiography Rhythm Disorders
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Littmann L. Symptomatic Bradycardia: Hold the β-Blocker? JAMA Intern Med. 2022;182(7):770–771. doi:10.1001/jamainternmed.2022.1558
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