McGill Case 342

This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia. Previous Case: McGill Case 341 | Next Case: McGill Case 343

This is a recording from an older man in the surgical intensive care unit. He was recovering from a motor vehicle accident where he sustained a chest injury from his seat belt. The rhythm is sinus rhythm with a prolonged p wave duration in lead III( >140ms) and a pronounced terminal negativity in V1 suggtestive of left atrial abnormality. The QRS is wide with a duration of 137ms and a superior and right ward axis. There is an Rsr' in V1 ahd the S wave is greater than the R in V6. This is an unusual pattern for aberrance and is more in keeping with ventricular ectopy. In this case thought this appears to be a right bundle branch block with a possible left posterior hemi-block. Of note, in spite of this conduction disturbance the patient was able to sustain reentrant supraventricular tachycaridas requiring intravenous adenosine for termination.