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Europace Advance Access originally published online on September 18, 2008
Europace 2008 10(11):1346-1347; doi:10.1093/europace/eun255
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

EHRA EDUCATION COMMITTEE: EDUCATION IN EP

A patient with long QT, sinus bradycardia, and ventricular ectopy: part I

Bas A. Schoonderwoerd1,* and Isabelle C. van Gelder1,2

1 Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; 2 Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands

* Corresponding author. Tel: +31 50 361 6161, fax: +31 50 361 4391. E-mail address: b.a.schoonderwoerd{at}thorax.umcg.nl


   Introduction
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 Introduction
Questions
 
A 55-year-old woman presented to our outpatient department with complaints of fatigue, dizziness, and dyspnea on exertion since 1 year. She reported impaired exercise tolerance when playing tennis. She has never experienced syncope. She had a history of hypertension, hypercholesterolaemia, and atypical angina for which she was treated with eprosartan 600 mg, rosuvastatin 10 mg, and hydrochlorothiazide 25 mg, once daily. Coronary artery disease was ruled out by angiography 2 years ago.

Her family history was unremarkable for sudden death, muscular diseases, or pacemakers but was positive for coronary artery disease.

Physical examination demonstrated a blood pressure of 125/70 mmHg, normal heart and pulmonary sounds. Laboratory tests, including electrolytes, were normal. Echocardiography demonstrated normal systolic and diastolic left ventricular function and good right ventricular function. There were no significant valvular abnormalities. All cardiac dimensions were within normal values. Cardiac MRI was completely normal.

Figure 1 shows the 12-lead ECG in rest (panel A) and during exercise (panel B). Figure 2 shows Holter tracings.


Figure 1
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  		Figure 1 12-Lead ECG at rest (A) and during exercise (B).

 


Figure 2
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  		Figure 2 24-h Holter tracings.

 

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  1. What abnormal findings can be seen on the tracings?
  2. What underlying conditions might explain these findings?


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Related articles in Europace:

A patient with long QT, sinus bradycardia, and ventricular ectopy: part II
Bas A. Schoonderwoerd and Isabelle van Gelder
Europace 2008 10: 1353-1354. [FREE Full Text]  




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