McGill Case 355

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 354 | Next Case: McGill Case 356

This is a regularly irregular rhythm. The PR interval is about 200 ms, and the QRS duration of the narrow beats is about 80 ms. There are Q waves in the inferior leads and there is T wave inversion in leads I, aVL, V4 to V6. The wide complex beats have a duration of 130 ms and have a LBBB configuration. Note the bump in the beginning of the ST segment in leads V1, V2 and II suggestive of a P wave buried in this area. Note also the compensatory pause after the wide beats. This is a recording of sinus rhythm with ventricular premature beats in trigemini. The inferior Q waves suggest an inferior MI.