VERY DIFFICULT to interpret this - because the tracing is vertical ... - and it printed out dark - and the image is too small when I tried to download (so that I could light and rotate).
It is not AFib - and not simple sinus. There are P waves - albeit of low amplitude and difficult to track - but they DO appear to be regular in the long lead II rhythm strip below the tracing. The 4th beat is early - most probably because it is conducting (with a long PR). The 3rd beat from the end is also early- probably also conducting. So - sinus rate in mid 50's with only intermittent capture beats (with long PR).
The QRS is wide - with LBB morphology. NO CHANGE in QRS morphology on the rhythm strip. Therefore - I suspect there is AV Dissociation - both by default (sinus bradycardia) - and by a slightly accelerated junctional pacemaker (~70/minute) - with intermittent capture.
Probable LVH despite LBBB (very deep S in V2) - and NO unusual ST-T changes (ST elevation in V2 is part of the LBBB, and not disproportionately elevated given the very deep S in that lead).
LBBB with AF.....
ReplyDeleteThe pt in sinus rhytm , right how it can be AF?
Deletelong QT syndrome
ReplyDeleteAtrial fibrillation with pre-existing left bundle branch block
ReplyDeleteAtrial fibrillation with pre-existing left bundle branch block
ReplyDeleteVERY DIFFICULT to interpret this - because the tracing is vertical ... - and it printed out dark - and the image is too small when I tried to download (so that I could light and rotate).
ReplyDeleteIt is not AFib - and not simple sinus. There are P waves - albeit of low amplitude and difficult to track - but they DO appear to be regular in the long lead II rhythm strip below the tracing. The 4th beat is early - most probably because it is conducting (with a long PR). The 3rd beat from the end is also early- probably also conducting. So - sinus rate in mid 50's with only intermittent capture beats (with long PR).
The QRS is wide - with LBB morphology. NO CHANGE in QRS morphology on the rhythm strip. Therefore - I suspect there is AV Dissociation - both by default (sinus bradycardia) - and by a slightly accelerated junctional pacemaker (~70/minute) - with intermittent capture.
Probable LVH despite LBBB (very deep S in V2) - and NO unusual ST-T changes (ST elevation in V2 is part of the LBBB, and not disproportionately elevated given the very deep S in that lead).
Overall - a very interesting tracing ...
Thanks for the detailed interpretation
DeleteComplete LBBB + AF
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ReplyDelete