Newsletter Atrial Fibrillation – ECG Case Discussion This ECG was recorded from a 60-year-old man being treated as an out-patient for severe congestive cardiac failure. What might be the diagnosis of the underlying heart condition and what would you do? Answer Atrial fibrillation Ventricular rate 75-200/min Normal axis Normal QRS complexes Downward-sloping ST segment depression, especially in leads V5, V6 Clinical interpretation The ventricular rate is not adequately controlled, though the ST segment depression suggests that he is taking digoxin. There are no changes to suggest ischaemia. What to do? In the absence of clinical or ECG evidence of ischaemia, possible diagnoses include rheumatic heart disease, thyrotoxicosis, alcoholic heart disease, and other forms of cardiomyopathy.Echocardiography is necessary. The serum digoxin level must be checked and the digoxin dose increased if appropriate. In addition to digoxin, the patient will need an angiotensin-converting enzyme inhibitor, a diuretic and, probably, anticoagulants. Beta-blockers must be considered once his cardiac failure is controlled. Click the button below to Download 500+ High-Yield Medical Presentations and eBooks Get Lifetime Access to 500+ Medical Presentations and eBooks Share this : Library Anatomy Anesthesiology Biochemistry Cardiology Dermatology Emergency Endocrinology ENT Examinations Forensic Med. Obs. & Gynae. Hematology Medicine Microbiology Nephrology Neurology Oncology Ophthalmology Orthopaedics Paediatrics Parasitology Pathology Pharmacology Physiology Psychiatry Pulmonology Radiology Rheumatology Surgery