Thoughts on this ECG

[Adonis]

Took over from another crew and they left this ecg lieing around. Any thoughts on what's going on here.

Just plain 12 lead reading. trying to improve on my reading.

[co2rescue]

Looks sinus brady with BBB. Rate appears 30 to 40

[Bieber]

I see a third degree AV block with a left bundle branch block.

Edited February 5, 2011 by Bieber

[Tom B.]

3rd degree AV block with junctional escape rhythm. Nonspecific ST-T abnormality. Notched J-point in several leads. Correlate with history and clinical presentation.

Tom

[wrmedic82]

I will agree with 3rd degree AV Block w/ Left Bundle Branch Block.

Here is my evidence

The atrial rate is about 50 bpm

The ventricular rate is 30-40 due to some irregularities

There does not appear to be any relationship between the P wave and the proceding QRS.

If you look at the 2nd beat the QRS is a little different than that of the rest of the other beats in lead II. Chances are the P wave is buried within the QRS. Also the 3rd beat look at the T wave. It is different from any of the other T waves. More than likely again the P wave is buried within the T wave.

The widened QRS with downward deflection in V1 makes the diagnosis of Left bundle branch block. Recall a normal QRS is <0.10 sec or 2.5 small boxes.

With this evidence its safe to diagnosis this as 3rd degree AVB with LBBB

Hope this helps.

Edited February 5, 2011 by wrmedic82

[tniuqs]

Maybe someone should be a lot more careful cleaning up ?

Could someone go find the pacer for me ... thanks.

Edited February 5, 2011 by tniuqs

[DwayneEMTP]

Wide qrs is secondary to a LBBB?

How wide should the qrs be when it's ventricular in nature? Does there need to be a block to create this tracing?

Good on you for catching the 3rd degree. I was curious to see how many were going to jump on brady/block.

Dwayne

[Tom B.]

Rs complex in lead I with a tight R-wave so definitely not a LBBB.

[uglyEMT]

Could it be Long QT Syndrome?

I am definatly not an expert but started learning EKG a little while ago.

[Doczilla]

2nd degree type 2 AVB with junctional escape beats. Look at the pattern of QRS complexes. Some are closer together, and some farther apart (escape beats). You've got some nonconducted P waves, but the PR interval is regular on the P waves that are conducted.

The QRS itself is not particularly wide as you would see in a LBBB. It's narrow right up until the notched terminal portion of the QRS. This would be typical for early repolarization. With as slow as it is, this may be an early osborn wave of hypothermia. Although, all the osborn waves I've seen were wider than this, so I'm betting on early repol, which was probably preexisting to this presentation.

'zilla