This ECG is taken from an elderly woman who complains of feeling weak and tired. We have no other clinical information, unfortunately.
There is an obvious bradycardia, with more P waves than QRS complexes. Here is what we see:
* Atrial rate is around 115/min. and P waves are regular and all alike.
* Ventricular rate is around 35/min. and QRS complexes are regular and all alike.
* PR intervals, when they occur, are all the same at 162 ms.
* QRS duration is wide at 122 ms.
* QTc interval is prolonged at 549 ms.
What does this mean? There is sinus tachycardia with second-degree AV block because the atrial rate is over 100/min, but not all P waves are conducted. The AV block looks like a Type II (Mobitz II) block because the PR intervals are all the same. This is a reliable indicator of conduction. (Not third-degree AVB). The wide QRS complexes are due to right bundle branch block. The ECG signs of RBBB are: 1) wide QRS; 2) supraventricular rhythm; and 3) rSR’ pattern in V1 and Rs, with a wide little s wave, in Leads I and V6.