Example 24

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The ECG


  • Following the 7+2 steps:
    • Rhythm
      • The ECG shows a regular rhythm. Every P wave is followed by a QRS complex. P waves are positive in I and AVF. Normal sinus rhythm
    • Heart rate
      • about 80bpm
    • Conduction (PQ,QRS,QT)
      • In lead II: PQ: 210ms QRS: 90ms QT: 380ms QTc: 450ms
    • Heartaxis
      • QRS positive in I and AVF: normal heart axis
    • P wave morphology
      • Broad based P waves
    • QRS morphology
      • Normal QRS complexes
    • ST morphology
      • Typical ST elevation in V1, V2 and V3, with a coved type morphology in V1.
    • Compare with the old ECG (not available, so skip this step)
    • Conclusion?


Typical Brugada syndrome ST segments in right precordial ECG leads (on spot diagnosis) aka 'type-1 Brugada ECG' with 1st degree AV block and broad P-waves.

Atrial/AV/ventricular conduction delay is commonly seen in Brugada syndrome, in this patient there is atrial and AV conduction delay. Brugada syndrome is associated with malignant arrhythmias (VT/VF) and sudden death although many patients may not experience any symptoms throughout their life.