Wide QRS

wide QRS complex is more than 2.5 mm (100 msec) at standard settings. This can be caused by ventricular rhythms / pacing or abnormal conduction e.g. bundle branch blocks, hyperkalemia, sodium channel blockade, pre-excitation or hypothermia. The QRS must be more than 3 mm (120 msec) to diagnose a complete bundle branch block.

See also: QRS width

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References

ECG Library (246)

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In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Weakness 12-Lead Concordant ST depression in V1-V3 Concordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Lateral MI Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
Elderly with Paced Rhythm, Possible Ischemic symptoms, and an Equivocal Smith Modified Sgarbossa ECG

This ECG is from a woman in her 80s who presented with a couple of days of shortness of breath, weakness and diaphoresis.

This ECG shows ventricular paced rhythm with concordant ST elevation V5-6 and concordant ST depression in V3. The cause was an occlusion of the circumflex.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Wide QRS Hyperkalemia Dr Smith's ECG Blog CC BY-NC
A 60-something who has non-specific generalized malaise and is ill appearing.

This ECG is from a man in his 60s who presented with generalised malaise.

This ECG shows very wide complexes due to hyperkalemia (8.9).

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Delta wave Wide QRS Wolff Parkinson White syndrome Dr Smith's ECG Blog CC BY-NC
A 40-something woman with no medical history presented with 2 days of chest pain

This ECG is from a woman in her 40s who presented with 2 days of chest pain.

This ECG shows widened QRS with delta waves due to Wolff Parkinson White syndrome. This was missed by the computer. There are secondary repolarisation changes.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Delta wave Wide QRS Wolff Parkinson White syndrome Dr Smith's ECG Blog CC BY-NC
What do you think about this Left Bundle Branch Block?

This ECG is from a man with recurrent episodes of tachycardia.

This ECG shows short PR interval with delta waves due to Wolff Parkinson White syndrome.

In the ECGquest archives, this ECG has been tagged with: - Loss of consciousness Seizure 12-Lead Irregular Narrow QRS Wide QRS Atrial fibrillation Change in rhythm Dr Smith's ECG Blog CC BY-NC
What is this tachycardia that alternates from wide to narrow to wide?

This ECG is from a patient in their 50s who presented unconscious and tachycardic after a seizure.

This ECG shows alternating wide and narrow complex tachycardias at the same rate, likely due to aberrancy.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Palpitations 12-Lead RSR' Wide QRS RBBB EMergucate CC-BY-NC-SA
ECG of the Week – 8th April 2019 – Interpretation

This ECG is from a woman in her 30s who presented with palpitations and intermittent shortness of breath.

This ECG shows wide QRS with RSR' in V1 and wide S in V6, consistent with RBBB.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain 12-Lead Excessive discordant ST elevation Wide QRS Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
Following Criteria Exactly, even the Modified Sgarbossa Criteria, Can Be Deadly – ECG 2

This ECG is from a man in his 70s who presented with epigastric pain.

This ECG shows These discordant ST changes are excessive and do meet Modified-Sgarbossa criteria. This was missed. The patient went into VF shortly after and died.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain 12-Lead Discordant ST changes Wide QRS ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
Following Criteria Exactly, even the Modified Sgarbossa Criteria, Can Be Deadly

This ECG is from a man in his 70s who presented with epigastric pain.

This ECG shows LBBB with discordant ST changes that do not quite meet Modified-Sgarbossa criteria. A repeat ECG showed evolution to excessive discordance. The patient went into VF shortly after and died.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Inferior ST elevation Wide QRS Interventricular conduction defect Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
IVCD, Saddleback STE in III, with reciprocal STD in aVL: Is it pseudoOMI or OMI? Echo with Speckle Tracking gives the answer.

This ECG is from a woman in her 70s who presented with acute chest pain and dyspnoea on a background of hypertension and congestive heart failure.

This ECG shows inferior ST elevation with an abnormally wide QRS (intraventricular conduction delay). The cause was an acute inferior MI.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Tachycardia Wide QRS Change in rhythm Wide complex tachycardia Bifascicular block LAFB RBBB Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
What is this rhythm? And what else does it show?

This ECG is from a man in his 60s who presented with abdominal pain dyspnoea and altered level of consciousness, in shock.

This ECG shows wide complex tachycardia with concordant ST elevation in V4-6, due to LAD occlusion. The rhythm was likely sinus tachycardia with RBBB and then LAFB mid way through the trace.

In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest 12-Lead Bradycardia Irregular Peaked T waves Wide QRS Hyperkalemia Dr Smith's ECG Blog CC BY-NC
A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB).

This ECG is from a patient who presented after a PEA arrest with ROSC after intubation and chest compressions.

This ECG shows irregular, slow, wide complex rhythm with peaked T waves due to hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead R in aVR Wide QRS Sodium channel blocker toxicity ECG of the Week CC-BY-NC-SA
ECG of the Week – 18th February 2019 – Interpretation

This ECG is from a man in his 60s who presented following a dothiepin overdose.

This ECG shows wide QRS with R in aVR and RBBB morphology, caused by sodium channel toxicity.

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