ECG challenge: a paradoxical response
Yew Chung Chan, Darcy Jamih, Hong Yee Lim · 2026
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Description
Yew Chung Chan, Darcy Jamih, and Hong Yee Lim present a heart tracing puzzle for clinicians, in this 2026 ECG challenge. Their patient was a sixty-five-year-old man sent for checks after a slow heartbeat was found by chance. He felt mostly well, with only slight loss of exercise stamina. His tracing showed a faulty electrical relay in the heart: only every second signal, roughly, was reaching the lower chambers.
Two bedside tests then behaved in opposite ways. Massaging the neck artery, which usually slows conduction, oddly restored a one-to-one rhythm. Meanwhile atropine, a drug that usually speeds conduction, made the block worse, pushing it toward near-total failure. Such paradoxical answers help locate where in the relay system the fault sits, which decides whether the patient needs a pacemaker and of what kind. The piece walks readers through the tracings before revealing the reasoning.
Catalog record
| CREATOR | Yew Chung Chan, Darcy Jamih, Hong Yee Lim |
|---|---|
| YEAR | 2026 |
| COLLECTION | PAPERS |
| FORMAT | TXT |
| FILE SIZE | 6 KB |
| VERSION | 1.0 |
| LICENSE | CC BY 4.0 |
| RIGHTS | CC BY |
| SOURCE | Europe PMC |