78 year old lady approached the ED with complaints of shortness of breath for last 3 - 4 days. She is hypertensive lady with Moderate Aortic Stenosis for last several years on regular medical treatment. She is being treated with Ecosprin, Metaprolol, & Spironolactone. The relatives attending the patient added that her pulse was around 50's for last 2 -3 days which her family physician attributed to her beta blockers. She has no symptoms at present. Her BP is 90/70 mm Hg, and her pulse in 36/min. Her chest has bilateral crackles, but her saturation is 95 % on room air. The EKG rhythm is as shown below. Her serum electrolytes were within normal limits, and there was no acidosis on blood gas analysis readings. What is your diagnosis?
The lady was diagnosed to be in complete heart block. As she was hypotensive, 0.5 mg of intravenous Atropine was administered, but there was no response on her pulse and BP. Cardiology consult was done, and transcutaneous pacing was recommended. The transcutaneous pacing was not helpful and intravenous temporary pacing procedure was recommended. After obtaining informed consent, right IJV was cannulated under ultrasound guidance and pacing sheath introduced using Seldinger Technique under LA. The pacing wire was introduced, and patient was placed on temporary pacemaker (Sn 1.0, I 3.0 mA, Rate 70). Post procedure, patient's pulse was 70, BP 120/70. Patient was shifted to the CCU under the care of the attending cardiologist. Post procedure XRC, & EKG rhythm strip is as below:
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