This ECG is taken from an 82-year-old man who called 911 because of chest pain. He has an unspecified “cardiac” history, but we do not know the specifics.
Right bundle branch block
This ECG is a good example of sinus rhythm with aberrantly-conducted PACs. The tracing was donated to the ECG Guru several years ago by Dr. Ahmed from Sanjiban Hospital in India. We have no patient data for this tracing.
This ECG is from a 59-year-old man who was a patient in the Emergency Department with mild chest pain. He had a history of coronary artery disease. We have no other information about his medical history, medications, or outcome.
This interesting ECG is a great one for your more advanced students who are ready to discuss the anatomical and physiological differences between the AV blocks, as opposed to just measuring PR intervals.
This is an example of right bundle branch block - with a couple of twists. It has the usual ECG characteristics of right bundle branch block: widened QRS (154 ms), supraventricular rhythm (sinus bradycardia), and an rSR' pattern in V1. In addition, wide little S waves are clearly seen in Leads I and V6. This secures the diagnosis of right bundle branch block (RBBB). Each QRS complex in every lead starts off with a very normal appearance, or morphology. Then, as the right ventricle is depolarized late, an additional wave is "added on".
This ECG depicts an extensive and ultimately, fatal, injury. There is marked ST segment elevation in Leads V2 through V6 (anterior wall). There is also ST elevation in Leads I and aVL (high lateral wall). The ST elevation in aVR is indicative of a very proximal lesion in the left coronary artery, which supplies the anterior wall, including the anterior portion of the septum, the high lateral wall, and, in this case, the low lateral wall. The inferior leads, II, III, and aVF, show reciprocal ST depression.
This ECG shows two obvious abnormalities, right bundle branch block AND inferior wall M.I. It is also a good teaching example of how the terminal wave of RBBB can be mistaken for the ST elevation of M.I.
First, check this ECG to see if it meets the criteria for right bundle branch block:
1) The QRS will be wide. That is, it will be greater than or equal to .12 seconds (120 ms). In this case, the QRS is 134 ms.
This ECG was obtained from a patient who suffered an occlusion of the left main coronary artery. ST elevation is seen in Leads V1 through V6, as well as I and aVL. This is an indicator that the circumflex artery is included in this M.I., and the occlusion is above the bifurcation of the LM and the circ. The patient also has a right bundle branch block and a left posterior fascicular block.
No instructor's collection should be without an atrial paced rhythm OR a right bundle branch block. Here, you get both. First, the atrial pacing. This patient had a sinus node problem, but his AV conduction system was functional (if not perfect). At this time, he is able to conduct impulses from the atria to the ventricles. What he cannot do is reliably produce the impulse in his atria. So, this pacemaker is currently pacing the right atrium, producing a paced "P" wave, which is then conducted to the ventricles.
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