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.

Featured Example

References

ECG Library (249)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypertension 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm ST Elevation

This ECG is from a woman in her 50s who presented with chest pressure on a background of heart failure and hypertension. BP 223/125.

This ECG shows sinus rhythm, LBBB and anterior ST elevation. Sgarbossa positive but modified sgarbossa negative. Echo showed LVH, troponin did show a rise and fall, MIBI showed normal perfusion. The most likely cause was a type II MI. The ECG changes did not evolve and were likely baseline changes.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over!

This ECG is from a middle aged man who presented with chest pain and diaphoresis while exercising. He had a VSD repair at age 6.

This ECG shows sinus tachycardia with RBBB + LPFB. ST elevation in III and aVF with reciprocal ST depression in aVL. ST depression in V2-5. The cause was inferoposterior MI, due to severe triple vessel disease and a culprit 100% circumflex occlusion.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain Chest pain 12-Lead Coved ST elevation Peaked T waves Tachycardia Wide QRS Sinus tachycardia Hyperkalemia Dr Smith's ECG Blog CC BY-NC
Do you recognize this ECG yet?

This ECG is from a man in his 30s who presented with chest pain and RUQ abdominal pain, on a background of type 1 diabetes. His BSL was high.

This ECG shows sinus tachycardia with a wide QRS, R in aVR, coved ST elevation and peaked T waves. The cause was hyperkalemia.

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 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: - 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: - Chest pain Dyspnoea 12-Lead Inferior ST elevation Wide QRS Intraventricular conduction delay 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.

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