Parkinson’s Disease & AF

Report:

Atrial fibrillation

Nonspecific ST/T changes

Somatic tremor

Comment:

The patient had severe, disabling parkinsonism. Atrial activity is difficult to make out, but the irregularly irregular ventricular rate points to atrial fibrillation.

Presence of simultaneously recorded channels relatively free of movement artefact (like lead 3 here) greatly facilitates the diagnosis.

The tremor is not particularly suggestive of Parkinson’s disease, which often produces a faster, undulating artefact at about 5/sec, identical to the usual rate (300/min) of atrial flutter.

Below (Fig 127a) is an example of familial essential tremor from another patient, a 56 year old man about to start propranolol therapy. The ECG proper is normal, apart from a VEB at the end.

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