McGill Case 365

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 364 | Next Case: McGill Case 366

The rhythm is sinus rhythm at about 65/minute, with a PR interval of 200 ms. The QRS has a left axis deviation. There is a poor R wave progression across precordial leads. This suggests a left aterior hemi-block and a possible remote aterior wall myocardial infarction. There is also a multiform ventricular couplet (second and third beat) as well as a blocked PAC seen in the ST segment of the 6th beat. The 9th beat is a ventricular premature beat.