Case description
A 67-year-old female patient presents with nausea, repeated vomiting and generalized weakness.
The symptoms began approximately five to six hours before presentation.
She denies:
- Chest pain
- Dyspnea
- Dizziness
- Syncope
- Fever
- Other complaints
Past medical history
- Diabetes mellitus
- Arterial hypertension
- Cardiac disease of unspecified nature
Medications
- None reported.
Vital signs
- Blood pressure: 135/80 mmHg
- Heart rate: 65/min
- Respiratory rate: 16/min
- Oxygen saturation: 98 % (room air)
- Body temperature: 36,8 °C
- Blood glucose: 108 mg/dl
EKG
Aufnahme
ECG summary
- Regular sinus rhythm with a heart rate of 60/min.
- Biphasic P wave in V1 suggesting left atrial enlargement (LAE).
- PR interval 200 ms (upper normal limit), no first-degree AV block.
- QRS duration > 120 ms, deep broad S waves in V1–V3 and discordant ST-segment and T-wave changes, consistent with a complete left bundle branch block (LBBB).
- No positive ischemic criteria with LBBB (Ischemic criteria negative).
Significance
The ECG shows a complete left bundle branch block and signs of left atrial enlargement. There are no positive ischemic criteria according to the Sgarbossa or modified Sgarbossa criteria.