Rosenbaum Extrasystoles

Report:

Sinus rhythm

VEBs in bigeminy

Borderline ST segment depression

Comment:

The VEBs look, at first, quite similar to sinus beats in the V1 rhythm strip. Two things show they are VEBs: the small but 0.04” thick initial R wave and the late S wave nadir, coming more than 0.06” after the QRS onset.

In the frontal plane, the VEBs have a right axis (not deviation, since VEBs do not have a range of normal axes). They are Rosenbaum extrasystoles, often seen in people with normal hearts. That’s why the broad R wave in V1 is called Rosenbaum’s normal pattern. Its significance is that it’s diagnostic of ventricular ectopy. Rosenbaum extrasystoles originate in the right ventricle. Although right ventricular VEBs have been shown in some studies to be more benign, they do not guarantee that the heart is in fact normal, nor are they confined to otherwise normal hearts.

The ST segment is horizontal in V6 and almost 1mm depressed in 2 and aVF. This may be a post-ectopic phenomenon – the poor man’s exercise test – or simply a false positive sign for ischæmia, not rare in women. La donna è mobile!

Two more examples are shown below (Figs 134a, 134b).

134a. Rosenbaum extrasystoles in 22 year old lady with palpitations. There is no clinical heart disease, but her PR interval is short (< 0.12”).

134b. Rosenbaum extrasystoles in a 76 year old woman with hypertensive LVH. 135. 46 year old lady with inferior infarction secondary to coronary artery spasm from migraine tablets.