ECG Review
How Many Findings?
By Ken Grauer, MD, Professor, Department of Community Health and Family Medicine, University of Florida. Dr. Grauer reports that he is sole proprietor of KG-EKG Press, and publisher of an ECG pocket brain book.
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| Figure. 12-lead ECG obtained from a 70-year-old man with chest pain for one day. |
Clinical Scenario: The ECG in the Figure was obtained from a 70-year-old man who presented with a history of chest pain for one day. How would you interpret his ECG? How many remarkable findings do you see on this tracing?
Interpretation/Answer: The lead II rhythm strip at the bottom of the tracing shows the rhythm to be sinus bradycardia and arrhythmia, with the rate at times dropping below 50 beats/minute. The PR interval is normal. However, the QRS complex is clearly wide. QRS morphology is most consistent with a RBBB (right bundle branch block) pattern. Instead of the usual rSR' pattern that is typical of RBBB, a QR pattern with a prominent Q wave is seen in lead V1. In addition, there is ST segment elevation which is subtle in lead V1, but more obvious in leads V2 through V4. The ST segment is covered in leads I, aVL, V5, and V6—and there is T wave inversion in the inferior leads, as well as in lead V3. Taken together, these findings are strongly suggestive of recent (possibly ongoing) acute anterolateral infarction.
Finally, R wave amplitude is markedly increased in leads V5 and V6. Even though amplitude criteria for ventricular enlargement are clearly less reliable in the setting of conduction disturbances such as RBBB, the degree of amplitude increase (especially in lead V6) makes it likely that the patient has LVH (left ventricular hypertrophy).
The ECG image in this article was obtained from a 70-year-old man who presented with a history of chest pain for one day. How would you interpret his ECG? How many remarkable findings do you see on this tracing?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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