ECG Challenge

| May 3, 2018 | ECG / Electrophysiology, ECG Library | 8 Comments

Salient findings and diagnosis?

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About The Author

Johnson Francis

Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal

8 Comments
  1. Dr Syed Aijaz Nasir

    RBBB,RAD (NORTHWEST),LPFB

  2. saikoran

    RAD
    RVH
    Incomplete RBBB
    Subtle STE in lead 3
    Possibilty of pulmonary embolism should be considered if it is acute in presentation

  3. Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London

    That was an instantaneous response! But North West axis should have QRS negative in lead I and aVF. Here the QRS is positive in aVF.

  4. Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London

    Why incomplete RBBB? QRS width is almost 160 ms – check for the widest QRS in standard leads.

  5. Jorik

    Rvh
    Rbbb
    Right axis.
    Right ventriculair strain pattern II,III and avf sadle brugada like pattern v2

  6. SANDEEP BANSAL

    Rvh
    Rbbb
    Right axis.
    Borderline PR

  7. nikesh

    rbbb..lpfb….rad…..bifascicular block

  8. Christopher

    SR, RBBB, mean axis is rightward (pre-blocked frontal axis is normal). Of note is the monomorphic R-wave in V1, because with the normal pre-blocked axis I would expect at least an S-wave in V1. Perhaps that is lead positioning, prior posterior MI, or RVH.
    On a cold read, all of the ST/T-waves appear reasonable. However, you can imagine relative ST-depression in III and ST-elevation in aVL, pointing towards a subtle high lateral infarction. I would not leave that off the list of possibilities, but couch that against the patient’s presentation.