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Arrhythmia Recognition Webcast Series
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Practice ECG 15
This is another third-degree heart block with a sinus tachycardia and a wide escape rhythm. The QRS is wide with a bifascicular configuration of RBBB and LAH. This, once again, could represent one of two possibilities: (1) a ventricular pacemaker with a bifascicular pattern, or (2) a very slow junctional rhythm with an underlying bifascicular pattern. The first option is more likely. An old ECG would be very helpful in this instance to see what the patient's baseline pattern was prior to this event.
The presence of the wide T waves may be suggestive of a CNS event or an electrolyte problem. Think of the differential diagnoses when interpreting ECGs.
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