![]() ECG Blog #162 - LBBB with obvious STEMI.ECG Blog #198 - An Irregular WCT ( LBBB or IVCD).That said - Clinical correlation will be essential in order to know what to do with this tracing. That said - I suspect there are no acute ST-T wave changes. There is fragmentation in multiple leads, and this patient undoubtedly has significant underlying heart disease. An Echo would be revealing.īOTTOM Line: The ECG in Figure-1 shows sinus rhythm, a PAC, IVCD with marked QRS widening, and probable LVH. That said - the marked fragmentation with ST elevation in the anterior leads here could reflect left ventricular aneurysm. P.S.: It is admittedly difficult to assess ST elevation that occurs in association with QRS widening.On the other hand, IF the history suggested new-onset chest pain - then: i ) Close clinical monitoring ii ) Searching for prior tracings ( for comparison) iii ) Serial ECGs and troponin in the ED and, iv ) Stat Echo ( looking for wall motion abnormalities) - would all be indicated.IF the history was not worrisome - I would probably not feel the need for additional ECGs.I see little in the way of reciprocal ST depression in other leads. Although there is some J-point ST elevation in leads V1-thru-V3 ( and I could not on this single ECG alone rule out the possibility of an acute event early in its course) - I suspect this ST-T wave elevation is not disproportionate, given the deep S waves in these leads. However, this can not be diagnosed with certainty from this single ECG.įinally, pending clinical correlation - I would interpret the ST-T wave changes in Figure-1 as probably nonspecific. ![]() Given the above noted fragmentation in multiple leads - and - the small but wider-than-expected Q wave in lead aVL - it would not be surprising to learn that this patient has had prior infarction. PEARL #3 - Although there are QS complexes in leads V1-thru-V3 - this finding is not specific for prior anterior infarction in the setting of QRS widening.Therefore - it is highly likely that this patient also has LVH. ![]() The S wave in lead V2 measures 25 mm - and the S in lead V3 measures more than the 24 mm we see, because the S wave is still descending at the point that the ECG paper runs out. That said - the finding of very deep (ie, ≥25-30 mm ) S waves in one or more of the anterior leads in a patient with LBBB is highly correlated with LVH. This is because conduction defects alter the sequence of both ventricular depolarization ( during which time the QRS complex is written on the ECG) and repolarization ( during which time the ST-T wave is written).
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