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Search and discover over 2,500 ECG reports written by cardiologist and intensivist Dr George Nikolić OAM.
Alternating RBBB & LBBB?
Report: Sinus rhythm Second degree 2:1 AV block Alternating RBBB & LBBB Discordant PR intervals Left axis deviation -35o (in RBBB) Non-specific ST/T changes (during RBBB) Or: Conducted RBBB with 2:1 and advanced 2o AVB Ventricular escape beats Es
An Optical Illusion
Report: Sinus tachycardia 116/min First degree AV block PR 0.40â Normal axis Left bundle branch block QRS 0.125â Comment: This is one of the traces I originally misreported (as NPJT). One way for any ECG to find its way into this Library is to h
Positive Concordant Pattern: Masquerading BBB
Report: Sinus rhythm Left atrial abnormality Possible right atrial abnormality First degree AV block PR interval 0.22â Alternating atrial (?sino-atrial) pacemaker (rhythm strip)[!xe "Alternating atrial pacemaker!] Atrial bigeminy Right bundle bra
âTrifascicularâ Block
Report: Sinus rhythm Left atrial abnormality (LAA) First degree AV block PR 0.28â Left posterior hemiblock Right bundle branch block Old anterior infarction Comment: The term âtrifascicularâ is sufficiently polysyllabic and scientific-soundin
Xylocaine and the δ Wave
Report: Sinus tachycardia Wolff-Parkinson-White conduction Transient normal conduction following injection of 50 mg xylocaine Comment: This patient with postural hypotension ( 90 mmHg drop!) and on multiple medications, was seen in consultation with vi
LBBB: Negative Concordant Precordial Pattern
Report: Sinus rhythm PR interval 0.20â Left atrial abnormality Normal axis Left bundle branch block Comment: History of infarction and marked cardiomegaly are clues as to why there is a concordant precordial QS pattern. This example has normal axis
Left Axis Deviation in AV Canal Defect
Report:Sinus rhythm 88/min Left axis deviation â60o Incomplete right bundle branch block Comment:Although morphologically indistinguishable from LAHB, the LAD in AV canal defects has different pathology. One should always suspect ostium primum ASD or
Fat Parents With Lean Children
Report: Sinus rhythm SVEBs VEBs Intraventricular conduction delay Probable LBBB QRS 0.14â Ventricular fusion beats Comment: Rhythm strips are not the most reliable material for the diagnosis of a bundle branch block (or, for that matter, of any
Left Axis Deviation in WPW Conduction
Report:Sinus arrhythmia 58 â 100/min Left axis deviation â40o Wolff-Parkinson-White conduction, type âBâ Comment:Either type âAâ or âBâ can produce inferior Q waves, usually QS complexes; âAâ, of course, can mimic posterior infarcts
Right Axis Deviation in WPW Conduction
Report:Sinus rhythm 88/min Right axis deviation +110o Wolff-Parkinson-White conduction, type âAâ Comment:For ordinary clinical purposes WPW conduction is best divided into types âAâ and âBâ, from Rosenbaum's now remote 1945 classification.