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Vol. 72. Issue 4.
Pages 344 (April 2019)
Vol. 72. Issue 4.
Pages 344 (April 2019)
ECG Contest
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ECG, April 2019
ECG de abril de 2019
Zaira Gómez-Álvarez
Corresponding author

Corresponding author:
, Juan Carlos Gómez-Polo, Miguel Ángel Cobos-Gil
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
Related content
Rev Esp Cardiol. 2019;72:42010.1016/j.rec.2018.05.035
Zaira Gómez-Álvarez, Juan Carlos Gómez-Polo, Miguel Ángel Cobos-Gil
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The patient was a 76-year old man with hypertension and hypercholesterolemia. In the electrocardiogram performed during a preoperative procedure for inguinal hernioplasty, first-degree atrioventricular block was observed. On questioning, the patient reported no dyspnea, palpitations, dizziness, or syncope. An exercise test and a Holter-ECG were requested. During the exercise test, the traces shown in the Figure were recorded.


In view of the results, we can consider 4 diagnostic options:

  • 1.

    PR interval shortening due to enhanced atrioventricular node conduction

  • 2.

    Appearance of nodal rhythm

  • 3.

    Marked PR prolongation, reaching 560ms with P waves conducted by the second QRS complex (known as over-the-top phenomenon)

  • 4.

    Accessory pathway conduction

Submit your answer to The solution will be published in the next issue (May 2019). #ECGChallenge #RetoECG.

Copyright © 2018. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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