What do you think of this elderly man with " possible seizure " ?

Written by Pendell Meyers(with really great and thorough explanation of this finding by Ken Grauer).At my hospital, patients with any symptoms which could be vaguely interpreted as a possible stroke during the triage process are brought to the high acuity area and a provider is asked to do a " neuro check " , which involves a quick H and P and exam to determine if we should activate our stroke protocol.A man in his 70s was brought to me for a neuro check, and the triage providers commented that they were worried about a possible seizure as well. The patient was alert and oriented with normal vitals at triage. He stated that the last thing he remembers was sitting at his desk working on some paperwork, then he remembers being on the ground looking up at paramedics. His wife heard a noise and found him on the floor next to his desk. He could not recall feeling anything unusual prior to the event, was in good health earlier that day, and felt completely normal at the time of my evaluation with no complaints. Of note, he had an identical episode last week for which he did not seek medical attention.So I asked for an ECG as syncope was high in the differential.Here is his initial ECG:What do you think?Interpretation: Sinus rhythm with extreme 1st degree AV block (PR interval roughly 500 msec!)There is a narrow, regular QRS which could arguably meet morphology criteria for LAFB. The ST segments and T-waves are normal, but they are followed immediately by another wave that...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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