Poor man's CRT

2010 Cardiovascular Medicine  
A 79-year-old male was admitted to our outpatient clinic with symptomatic heart failure (HF). The patient reported impaired exercise tolerance with increasing shortness of breath in the previous 4 weeks and a weight gain of 5 kg. The ECG showed new onset atrial fibrillation (AF) with rapid conduction and preexisting left bundle branch block ( fig. 1) . The patient had a history of coronary artery disease with successful PCI of the LCX after inferolateral myocardial infarction 15 months
more » ... y. Medication consisted of acetylsalicylic acid, torasemide, and atorvastatin. Physical examination revealed positive hepatojugular reflux, normal blood pressure (110/85 mm Hg), irregular heart beat (approx. 110 at rest), and right sided pleural effusion. Echocardiography showed severely reduced left ventricular ejection fraction (15-20%) with signs of left ventricular dyssynchrony, moderate mitral regurgitation and severe tricuspid regurgitation. Figure 1 shows the patient's resting ECG; figure 2 shows a sequence of a 24-hour Holter ECG. THE INTERESTING ECG
doi:10.4414/cvm.2010.01470 fatcat:4roaiijzorhipp2nycmivor7v4