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75-Year-Old Lady with History of Hypothyroidism

A 75-year-old lady with a history of hypothyroidism (HT) presents with a period of a brief loss of consciousness after getting up from a chair to answer the phone. She became dizzy and passed out for a few minutes. She denies palpitations, chest pain, or shortness of breath. Her blood pressure (BP) is 138/68 and fell to 118/68 upon standing. The 12-lead electrocardiogram (ECG) is as follows:

scan 23 scan 26

Question 1: The ECG shows

  • A. Atrial fibrillation
  • B. Normal sinus rhythm
  • C. Left Bundle Branch Block (LBBB) with first-degree heart block
  • D. Ventricular tachycardia

Initial telemetry in the hospital was unremarkable. An event recorder was requested. The transmission is as follows:

Question (2) The above recording shows:

scan 23 scan 23

  • A. Atrial fibrillation and flutter
  • B. Ventricular standstill and torsades de pointes
  • C. Supraventricular tachycardia (SVT) and right bundle branch block (RBBB)
  • D. Junctional rhythm and aberrant conduction

The patient went into cardiac arrest, and after 6 minutes of cardiopulmonary resuscitation (CPR) and defibrillation, a return of spontaneous circulation was achieved. Blood electrolytes were normal. Below is a post resuscitation ECG.

Answers and Discussion

Question 1 Answer: Left Bundle Branch Block (LBBB) with first-degree heart block

Question 2 Answer: Ventricular standstill and torsades de pointes


Written by and last updated Dec 20, 2017

Last reviewed by on Dec 20, 2017