Broad QS Morphology in Standard and Left Precordial Leads

Report :

Sinus rhythm

VEB, possibly fusion beat

Runs of ventricular tachycardia 210 – 150/min

Non-specific ST/T changes

Probable old anterolateral infarction

Comment :

All the VT complexes have QS morphology. In the left precordial leads, this absence of R waves precludes the diagnosis of WPW conduction of either ‘A’ or ‘B’ type104.

In this case, one cannot be sure whether the runs are of sustained or non-sustained (less than 30 sec) variety, since only the onset of one and the termination of another run are recorded, conveniently leaving all 12 leads of the ECG for sinus rhythm.

Partly due to therapy of VT, her sinus became a sick sinus (below, 117a). The sinus capture beats (all the early ones) are a good example of the RP-PR reciprocity).

Just having a P wave in front of QRS is not enough (Fig 117b).

117a. Sinus bradycardia and junctional rhythm with sinus captures.

117b. Real captures are early, often fought over a long PR interval. The two in this trace are pseuds. Compare them to those in the previous trace. The main diagnostic point here is that the junctional rhythm remains regular throughout the AV dissociation.

118. 92 year old diabetic with chronic LBBB and heart failure secondary to hypertension and recurrent infarctions.