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    Jul 2008
    Northern Virginia

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    Default New onset Heart block

    An 81 y/o male presents for a right THR. Medical history is completely unremarkable with a few minor exceptions. He has a slight murmur. Pre-op echocardiogram shows mild MR, normal wall motion, EF 65%. Pre-op cardiac clearance (10 days prior) states that he has a 1st degree AV block (330 msec), and a left anterior fascicular block. (The EKG on the chart is a Xerox of a fax that was a Xerox of the original = completely useless.) Patient states that he used to exercise routinely, but has tapered off in the past few months due to hip pain. Home meds include baby ASA (stopped 10 days prior) and Vit B12.

    Anesthetic plan is GA. Pastient does not desired regional.

    Just prior to transport to the OR the patient is given 2mg versed, 100 mcg of Fentanyl. Once in the OR the patient was placed on standard monitors. PRIOR TO INDUCTION you see the following tracing in the monitor. (The posted EKG was done later on, I didnít think to keep a copy of the strip I ran in the OR).

    What rhythm is it? Is this a "normal" variant in patient with known first degree AVB? Does it warrant further investigation before pressing on, or do you think it would be safe to proceed?

    Students first please. Any and all thoughts most welcome.

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    Ignorance of one's ignorance, is the malady of the ignorant. James Almos

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