ECG Challenge – Discussion

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Salient findings and diagnosis?

ECG Challenge – Discussion

ECG shows sinus rhythm with heart rate around 83/min. QRS width is around 160 ms. rS pattern in lead I and QS in aVL would mean right axis deviation, in this case due to right posterior hemiblock. Notched R in V1 and rsr’s’ in V2 with slurred S in lead I, V5, V6 suggests right bundle branch block. Together these will constitute a bifascicular block. PR interval is 200 ms, the upper limit of normal. P wave is wide in leads II and III suggesting left atrial overload. But the negative component of P wave in V1 is not very prominent.
If PR interval prolongs further it will become trifascicular block, which is quite near a complete heart block.