Holter Ischæmia

Report:

Top:

Sinus tachycardia 105/min

SVEB

ST/T changes suggestive of ischæmia

Middle:

Sinus rhythm 80/min

Resolving ST/T changes

Bottom:

Sinus rhythm 66/min

Isoelectric ST segments

Comment:

This is a good example of spontaneous ischæmia (at 3.30 a.m.). A clue that the ST segment shift is not artefactual – e.g., positional – is that the QRS size and orientation are constant. Also the time of day (i.e., night).

No significant arrhythmias were detected. What was causing her falls? Arrhythmia cannot be ruled out unless falls in sinus rhythm are documented; ischæmia (presumably silent) is now a possibility. It could be relieved by angioplasty19. However, in a 90 year old lady, other causes of falling down abound.

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