Another two parter again this fortnight.
This ECG is from an 81 year old male.
|Click to enlarge|
- Sinus Rhythm
- LAD (<-30 deg)
- PR - Normal (~180-200ms)
- QRS - Prolonged (140ms)
- QT - 440ms (QTc Bazette ~ 430 ms)
- rsR' Pattern V1
- T Inversion aVR, V1
- Biphasic T wave V2
- Broad Notched P wave Lead II
- Notching of baseline following first QRS complex in leads I, II, III – likely artefact
- Bifasicular Block - RBBB + LAFB
- P Mitrale
- In the setting of syncope with bifasicular block with features suggestive of cardiac syncope or absence of other clear cause for syncope cardiology referral for consideration of prophylaxtic pacing is appropriate.
- (ACC/AHA/HRS 2008 Guidelines Class IIa Level B Recommendation)
- The clinical context of a RBBB is important in the clinical decision making. New onset RBBB with symptoms to suggest infarction would make you think of a proximal LAD lesion, proximal to the first septal perforator branch.
- Note that an LAD occlusion does not give a LBBB.
References / Further Reading
Life in the Fast Lane
- ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Title and subTitle BreakA Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) J Am Coll Cardiol. 2008;51(21):e1-e62 here
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.