ECG of the Week - 25th February 2013 - Interpretation

No clinical information on this one.

 

 

 

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Rate:

• 42

Rhythm:

• Regular ventricular complexes
• Irregular atrial activity
• Complexes 3 & 4 sinus

Axis:

• LAD (-50 deg)

Intervals:

• PR - Normal (~180-200ms) for 3rd & 4th Complexes only
• QRS - Prolonged (~120ms)
• QT - 720ms (QTc Bazette ~ 600 ms)

Segments:

• Slight down sloping ST Depression V5-6

Additional:

• T wave inversion I, aVL, V1, V3-6
• QRS Morphology RBBB Pattern
• Differing QRS Morphology between complexes 1-2,5-7 and complexes 3-4
• Difficult to map atrial activity given relative low voltage p wave
• R wave progression abnormal across precordial leads
• ? V2 misplacement - terminal deflection QRS >> than V1&2 with positive T wave

Interpretation:

• Intermittent trifasicular block likely complete
• Bifasicular block with variable sinus capture & high grade AV block

References / Further Reading

 

Life in the Fast Lane

 

• Trifasicular Block here

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.