PMC3921998_01
ECG showing anterolateral ST elevation.
edmcr-2013-130058-g001.jpg
PMC3921998_01_edmcr-2013-130058-g001.jpg
fig1
After his physician review was complete, an electrocardiogram (ECG) was performed as part of his routine annual assessment (Fig. 1).
Absent heart rate response to controlled deep breathing (six breaths per minute). Event mark: recording during controlled deep breathing.
edmcr-2013-130058-g002.jpg
PMC3921998_01_edmcr-2013-130058-g002.jpg
fig2
This is consistent with a diagnosis of autonomic neuropathy (Figs 2, 3 and 4).
Diminished heart rate response to phases II and IV of Valsalva manoeuvre. Event mark: the beginning of the test.
edmcr-2013-130058-g003.jpg
PMC3921998_01_edmcr-2013-130058-g003.jpg
fig3
This is consistent with a diagnosis of autonomic neuropathy (Figs 2, 3 and 4).
Absent heart rate response to tilting up on tilt table test at 1 min. Note absent postural drop with absent reflex tachycardia. Event mark: the beginning of tilting up.
edmcr-2013-130058-g004.jpg
PMC3921998_01_edmcr-2013-130058-g004.jpg
fig4
This is consistent with a diagnosis of autonomic neuropathy (Figs 2, 3 and 4).