Intraventricular conduction delay https://www.ecgguru.com/taxonomy/term/812/all en Non-specific IVCD With Peaked T Waves https://www.ecgguru.com/ecg/non-specific-ivcd-peaked-t-waves <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/non-specific-ivcd-peaked-t-waves"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LAH102.jpg" width="1800" height="1279" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><strong><span style="color: #00b050;">The Patient:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">   </span></span>This ECG was obtained from an elderly man who was suffering an exacerbation of congestive heart failure.<span style="mso-spacerun: yes;">  </span>He had a history of CHF and hypertension.<span style="mso-spacerun: yes;">  </span>We do not have other history available to us.</p><p class="MsoNormal"><strong><span style="color: #00b050;">The ECG:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">  </span></span>The <strong>rhythm is sinus at 97 bpm</strong> (fast for this patient). It is regular with no ectopy.<span style="mso-spacerun: yes;">  </span>The <strong>PR interval is 155 ms</strong> (.15 seconds), and the P waves are upright in the inferior leads. The frontal plane QRS <strong>axis is -56 degrees</strong> – abnormally leftward.<span style="mso-spacerun: yes;">  </span>Notice that Leads II, III, and aVF are all negative.<span style="mso-spacerun: yes;">  </span>AVR is equiphasic – the axis travels perpendicular to the positive electrode of aVR, toward the patient’s left shoulder.<span style="mso-spacerun: yes;">  </span>The <strong>QRS duration is 111 ms (.11 sec.).</strong><span style="mso-spacerun: yes;">  This is very close to being wide enough for a diagnosis of left bundle branch block, and represents poor conduction throughout the ventricles. </span>On the chest leads side, there is <strong>poor R wave progression. </strong>V1 through V4 look almost the same, small r and large S.</p><p class="MsoNormal">The ST segments are generally concave up, and the J points are at the baseline – <strong>no ST elevation or depression.<span style="mso-spacerun: yes;">  </span></strong>There are <strong>no pathological Q waves</strong>, unless we count V1, which may have lost it’s Q wave as part of the general poor R wave progression.</p></div></div></div> Mon, 31 May 2021 19:58:30 +0000 Dawn 798 at https://www.ecgguru.com Inferior Wall M.I. With Wide QRS and Complete AV Block https://www.ecgguru.com/ecg/inferior-wall-mi-wide-qrs-and-complete-av-block <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/inferior-wall-mi-wide-qrs-and-complete-av-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IWMI%20LBBB%20101_0.jpg" width="1800" height="802" alt="" /></a></div><div class="field-item odd"><a href="/ecg/inferior-wall-mi-wide-qrs-and-complete-av-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IWMI%20WC%20101%20Follow%20up%20post%20cath.jpg" width="453" height="132" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="font-size: 13.008px;">This ECG is from a 66-year-old woman who called 911 for a complaint of chest pain for the past four hours. She also complained of nausea, vomiting, and diarrhea for that time.</span><span style="font-size: 13.008px;"> She was pale and diaphoretic, and her BP was 77/43 sitting up, improving to 90/54 reclining. </span><span style="font-size: 13.008px;">She denied “cardiac” history.</span><span style="font-size: 13.008px;">  </span><span style="font-size: 13.008px;">Her medications included:</span><span style="font-size: 13.008px;">  </span><span style="font-size: 13.008px;">aspirin, an SSRI, cilostazol, amlodipine, umeclidinium and vilanterol inhaler, atorvastatin, levothyroid, and metoprolol. We don’t have a previous ECG.</span><span style="font-size: 13.008px;">  </span><span style="font-size: 13.008px;">The EMS crew followed their chest pain protocol and delivered the patient to a facility with an interventional cath lab, but they did not designate a “STEMI Alert” because of the wide QRS.</span><span style="font-size: 13.008px;">  </span><span style="font-size: 13.008px;">It is their protocol to use the term “STEMI Alert” only when no M.I. mimics, such as left bundle branch block, are present.</span><span style="font-size: 13.008px;"> </span></p><p class="MsoNormal"><strong>What does this ECG show?     </strong>There is an underlying sinus rhythm at 75 bpm.  There is AV dissociation, with regular, wide QRS complexes at a rate of 44 bpm.   This meets the criteria for complete heart block (third-degree AV block).  The morphology of the QRS complexes meets the criteria for left bundle branch block (wide, upright in Leads I and V6, negative in V1).  At a rate of 44 bpm, several options for this escape rhythm are possible:  1)  junctional escape with LBBB, 2) junctional escape with intraventricular conduction delay due to AMI,  and 3) idioventricular escape rhythm.   Also, in the presence of IWMI, AV node ischemia is very likely, resulting in AV blocks at the level of the AV node.  CHB at the AV node would result in junctional escape rhythm, and CHB below that, in the fascicles of the bundle branches, would result in idioventricular escape. The issue for this patient, and ANY patient, is cardiac output, and we see several reasons for cardiac output to be lower:</p><p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;">·<span style="font-variant-numeric: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">         </span></span><!--[endif]--><strong>Wide QRS</strong></p></div></div></div> Wed, 28 Jun 2017 20:13:14 +0000 Dawn 733 at https://www.ecgguru.com