Heart block and nonocclusive mesenteric ischemia

Excerpt

An 88-year-old woman presented with 1 day of lower abdominal pain and bloody diarrhea. She claimed fatigue and dyspnea on exertion for the past 3 weeks. She had been healthy all her life and took no medications. She was afebrile with a heart rate of 40 beats per minute and blood pressure of 134/61 mmHg. Her abdomen was soft with minimal lower tenderness, and the exam was otherwise normal. Lab chemistries, lactate, and CBC were normal except WBC of 23.54. We obtained the ECG shown in Fig. 1 and the abdominal CT shown in Fig. 2. She was admitted to the cardiology service. We ordered the CT because we believed that any abdominal tenderness in such an elderly patient could indicate serious pathology, such as abscess, aortic aneurysm, or mesenteric ischemia.

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