Interpret this ECG

A 27-year-old male is presented with nausea, fatigue, tiredness & one episode of vomiting. His past medical history of fibromyalgia and is on medication for the same. Her BP is low as 80/50 mmHg; heart rate was 60 beats/min; temperature was 35.1 °C, respiration was 18 breaths/min; and oxygen saturation was 99%. ECG is attached. What is your opinion?



This is a broad complex rhythm First question is to ask is - Is the rhythm regular? Answer is no Rhythm is not regular, there is wide variation in RR internal as seen in long lead There are very few rhythm are not regular - most common is atrial fibrillation which is irregularly irregular So certainly this ECG is of atrial fibrillation Now - are P waves seen? There are no P waves seen - this again confirms diagnosis of atrial fibrillation Now there is something happening to QRS complexes, they are wide Lead V1 shows a positive deflection - so it is right bundle branch block Because this is never possible in left bundle branch block. In left bundle branch block lead V1 has negative and wide deflection that is deep S wave Therefore, in this case, this patient is having right bundle Diagnosis Atrial fibrillation with right bundle branch block

Thank you! Dr. Mansukh Shah

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Ecg shows sinoartrial block Perimyocarditis. Acute myocardial infarction (or ischemia) Drug side effects (procainamide, digitalis)

RAD,wide comlex irregularly irregular rhythm, drug toxicity? Electrolyts imbalance?? Needs electrolyts,,cal,mg, ECHO

Atrial fibrillation with RBBB Needs immediate attention and evaluation. Start treatment in ICU and constant monitoring advised.

? JB .. ? MI ..


Junctional bradycardia

Required further evaluation ECHO, TROP I

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