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IVCD

Wide QRS Complex With First-degree AV Block

Fri, 06/07/2019 - 14:48 -- Dawn

The Patient:  This ECG was taken from a 73-year-old man with a history of heart failure with preserved ejection fraction, severe left ventricular hypertrophy, Type II diabetes, and stage 4 chronic kidney disease.  He also suffered deep vein thrombosis and is on anticoagulation.  He has a recent diagnosis of IgA myeloma.  He presented with a complaint of nausea and vomiting and was found to have a worsening of acute kidney infection.  There was suspicion of renal and cardiac amyloidosis, but the patient refused biopsy to confirm this.  He was started on chemotherapy for multiple myeloma and will be followed as an outpatient.

The ECG:  The rhythm is sinus at around 60 bpm, although the rate varies a little at the beginning of the strip.  The QRS complex is wide at .12 seconds, or 120 ms., representing interventricular conduction delay (IVCD).  The PR interval is .32 seconds, or 320 ms. This constitutes first-degree AV block.  There is left axis deviation in the frontal plane and poor R wave progression in the horizontal plane.

Instructors' Collection ECG: Wide QRS Complex With First-degree AV Block

Fri, 06/07/2019 - 13:40 -- Dawn

The Patient:  This ECG was taken from a 73-year-old man with a history of heart failure with preserved ejection fraction, severe left ventricular hypertrophy, Type II diabetes, and stage 4 chronic kidney disease.  He also suffered deep vein thrombosis and is on anticoagulation.  He has a recent diagnosis of IgA myeloma.

Atrial Fib To Cardiac Arrest

Sun, 07/03/2016 - 14:31 -- Dawn

A paramedic crew responded to the office of a local physician. A 61-year-old male presented with a one-week history of chest pain and shortness of breath. He had a previously undiagnosed atrial fibrillation with rapid ventricular response and left bundle branch block, but was alert. Shortly after transport commenced, the patient became unresponsive with Torsades de Pointes, which rapidly degenerated into ventricular fibrillation. The paramedic placed pads and defibrillated within one minute.  After two minutes of compressions, the patient had a fairly regular rhythm with return of spontaneous circulation.  Transport time was short.  On catheterization, the patient was found to have severe coronary artery disease, requiring coronary artery bypass graft surgery (CABG) A balloon pump was inserted in an attempt to strengthen him for surgery.

What is the rhythm?   The 12-lead ECG presented here shows atrial fibrillation at a rate of 138 per minute.  The rhythm is irregularly-irregular with no P waves.  Since the patient had not yet been diagnosed with atrial fib, obviously no therapy had been initiated to control the rate. There is a PVC near the end of the strip.

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