Wednesday, 16 May 2012

ECG of the Week - 14th May 2012 - Interpretation

No clinical information on this one.







Click to enlarge

Rate:
  • 78
Rhythm:
  • Regular
  • Sinus Rhythm

Axis:
  • LAD (-75 deg)
Intervals:
  • PR - Normal (~200ms)
  • QRS - Prolonged (~140)
  • QT - 400ms (QTc Bazette ~ 460 ms)
Segments:
  • Slight ST depression V2
  • Slight ST elevation II, III, aVF

Additional:
  • RBBB Morphology
  • T Inversion V1-3, aVR, aVL
  • Notching p waves in lead II

Interpretation:
  • Bifasicular Block - RBBB with LAFB

  • Note if 1st or 2nd degree AV with Bifasicular block then Incomplete Trifasicular Block
  • Risk of progression to complete heart block is low with bifasicular block and higher with trifasicular block
  • New bifasicular block can be associated with hyperkalaemia

References / Further Reading

Life in the Fast Lane
  • Bifasicular Block here
  • Trifasicular Block here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.