PMH: Angina, Gastric ulcer, no other relevant info, no information on p/t’s medications… This is just an exercise in 12-lead ECG interpretation…
Here’s a little help from me, please provide your ECG analysis & interpretation.
Rate:
Atrial: Unable to determine, irregular
Atrial: Unable to determine, irregular
Ventricular: 75-150, irregular.
Waves: Difficult to identify P waves, but can be identified in aVF, other appearance is fibrillation pattern, not consistent… Relation to QRS – None… Q waves NOT present… T waves present “Morpholology – Fused with QRS.
Intervals: P-R consistent, QRS: 0.16 secs, appearance: consistent, wide, positive RS in V6, negative QS in V1… QT interval: 0.40.
Axis: Quadrant: LAD… Degrees -40 (aVF and Lead II mostly isoelectic slightly negative.
Hypertrophy: No atrial or ventricular detected.
Other info: Q waves none significant for AMI… I see some ST displacement: ST elevation II, III, aVF, V1-5… ST depression 1, aVL, V6, no possible drug effects noted.
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wide complex tach.. irregular.. no p.. LBBB
ReplyDeleteAF+LBBB
it important to compair to an old ECG to see if the LBBB is new or old espically that he is having st elevation in inferior and septal leads
new LBBB+ST elevation pt is has new MI
wide complex tach, LBBB patttern, consider AF with pre-excitation (WPW). In aVF short PR, could be delta waves in III
ReplyDeleteAn interesting case, and I thank you for this contribution! Regarding irregularly irregular rhythm structures, I am not sure if the differential includes anything other than a-fib. In saying this I am excluding relatively transient phenomena/ effects like sick-sinus, frequent PACs/ PJCs/ PVCs, sinus arrhythmia, etc. Furthermore, I cannot visualize any P-waves in this tracing.
ReplyDeleteConcerning the LBBB morphology, left axis is certainly a consistent finding. With a QRS> 160ms, however, alternative or exacerbating etiologies might be at play-- for example TCA intoxication or hyperkalemia (although the later is much less likely given the absence of classic morphological features).
Thanks again for this interesting case!