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Vol. 71. Issue 2.
Pages 115 (February 2018)
Vol. 71. Issue 2.
Pages 115 (February 2018)
ECG Contest
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ECG, February 2018
ECG de febrero de 2018
Pablo Elpidio García-Granjaa,b,
Corresponding author

Corresponding author:
, María Sandín Fuentesa,b, Emilio García-Morána,b
a Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Related content
Rev Esp Cardiol. 2018;71:20710.1016/j.rec.2017.10.021
Pablo Elpidio García-Granja, María Sandín Fuentes, Emilio García-Morán
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A 68-year-old man with no known cardiovascular risk factors or relevant personal or family history was referred to the cardiology outpatient clinic by his primary care physician for an incidental finding of extrasystoles in the electrocardiogram (Figure). He did not show any cardiac symptoms. Structural heart disease was ruled out with transthoracic echocardiography. Treatment with β-blockers was initiated and a Holter study was requested. This showed monomorphic extrasystoles in 31% of beats.


Which mechanism can explain his electrocardiogram?

  • 1.

    Second-degree 2:1 atrioventricular (AV) block caused by disease intrinsic to the conduction system

  • 2.

    Sinus P waves blocked by incomplete penetration of the ventricular extrasystole in the bundle of His

  • 3.

    Atrial premature extrasystoles blocked by a refractory AV node

  • 4.

    Ventricular extrasystoles with retrograde conduction to the atrium

Submit your diagnosis to The diagnosis will follow in the next issue (March 2018). #RetoECG.

Copyright © 2017. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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