ECG Guru - Instructor Resources - Interventricular conduction defect https://www.ecgguru.com/ecg/interventricular-conduction-defect en Anterior-lateral M.I. With Wide QRS https://www.ecgguru.com/ecg/anterior-lateral-mi-wide-qrs <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/anterior-lateral-mi-wide-qrs"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AWMI128.jpg" width="1800" height="915" 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 style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">The Patient:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>An elderly man presents with chest pain, pallor, diaphoresis and weakness.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">The ECG:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span>The rhythm is normal sinus at a rate of about 76 bpm with normal intervals. The QRS complexes are wide at about .14 seconds (140 ms).<span style="mso-spacerun: yes;">&nbsp; </span>There is ST segment elevation in all precordial leads, except for possibly V6.<span style="mso-spacerun: yes;">&nbsp; </span>The shape of the ST segments in the anterior wall range from coved upward in a “frowning” shape (V1) to very straight (V5 and V6).<span style="mso-spacerun: yes;">&nbsp; </span>There is also ST elevation in aVL with ST straightening in Lead I.<span style="mso-spacerun: yes;">&nbsp; </span>There is ST depression in the inferior leads, II, III, and aVF.<span style="mso-spacerun: yes;">&nbsp; </span>Lead II is equally biphasic while I and aVL are positive, indicating an axis that is shifted slightly to the left.<span style="mso-spacerun: yes;">&nbsp; </span>With his symptoms and this alarming ECG, he was sent promptly to the cath lab.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">Interpretation:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>The rather obvious ST-elevation M.I. is extensive, covering the entire anterior wall, and extending into the high and low lateral walls . This was confirmed in the cath lab, as the patient had an occlusion of the left anterior descending artery near the bifurcation of the circumflex.<span style="mso-spacerun: yes;">&nbsp; </span>The wide QRS meets the criteria for left bundle branch block (wide QRS, negative QRS in V1 and positive QRS in V6 and Lead I).<span style="mso-spacerun: yes;">&nbsp; </span>However, it doesn’t have the “look” of LBBB with the low-voltage seen in the anterior wall. After the offending artery was opened and stented, the wide complex became narrow and was considered to be an interventricular conduction delay that was due to the ischemia.<span style="mso-spacerun: yes;">&nbsp; </span>The ST depression in the inferior wall is most likely reciprocal.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">Take-home points:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp; </span></span>“Normal sinus rhythm” does not mean that everything is “normal”.<span style="mso-spacerun: yes;">&nbsp; </span>Also, the SHAPE of the ST segment is as important as the elevation.<span style="mso-spacerun: yes;">&nbsp; </span>ST segments can be elevated in conditions other than acute M.I., and ST segments can be quite low and still be very abnormal.<span style="mso-spacerun: yes;">&nbsp; </span>Coved upward or straight ST segments are indicative of M.I.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/784/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Anterior-lateral M.I. 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With Wide QRS 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.8</span></span> <span class="total-votes">(<span >9</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-9IP7BbdvO4bzDeMFbZ--a-PmyXcNLVBMqx-2x190Bu4" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-lateral-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior-lateral M.I.</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item odd"><a href="/ecg/wide-qrs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide QRS</a></div><div class="field-item even"><a href="/ecg/hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hemiblock</a></div><div class="field-item odd"><a href="/ecg/fascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Fascicular block</a></div><div class="field-item even"><a href="/ecg/ivcd" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">IVCD</a></div><div class="field-item odd"><a href="/ecg/interventricular-conduction-defect" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Interventricular conduction defect</a></div><div class="field-item even"><a href="/ecg/st-depression" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST depression</a></div><div class="field-item odd"><a href="/ecg/reciprocal-st-changes" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Reciprocal ST changes</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fanterior-lateral-mi-wide-qrs&amp;title=Anterior-lateral%20M.I.%20With%20Wide%20QRS"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Wed, 13 Nov 2019 05:56:24 +0000 Dawn 778 at https://www.ecgguru.com https://www.ecgguru.com/ecg/anterior-lateral-mi-wide-qrs#comments