Agonal Rhythm

Report:

Pacemaker rhythm 60/min 2

Absolute small voltage 3

Probable acute anterior infarction 5

Comment:

There is probably an atrial standstill.

The patient sustained clinical acute infarction and cardiogenic shock, dying within minutes of this trace being taken. The voltage loss and the bizarre complexes indicate an agonal rhythm, with reasonably convincing infarctional morphology in lead V2.

Previous ECG, taken 5 hours earlier, was unremarkable (Fig 116a). It is interesting that the “trifascicular” block preceded the presumably causal infarction. It would appear that, on evidence at hand, pacing does not, statistically, prevent death in patients with any combination of intraventricular blocks. It does, sometimes, buy a little time.

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