Wide QRS

A 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 complex

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References

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Inferior ST elevation Wide QRS Interventricular conduction defect Acute Inferior MI 12-Lead 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: - Tachycardia Wide QRS Change in rhythm Wide complex tachycardia Bifascicular block LAFB RBBB Positive Sgarbossa criteria 12-Lead 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 Bradycardia Irregular Peaked T waves Wide QRS Hyperkalemia 12-Lead Dr Smith's ECG Blog Dr Ken Grauer K. Wang 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: - R in aVR Wide QRS Sodium channel blocker toxicity 12-Lead 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.

In the ECGquest archives, this ECG has been tagged with: - Irregular Normal rate Tall U waves Wide QRS Atrial fibrillation Hypokalemia 12-Lead Dr Smith's ECG Blog CC BY-NC
Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG?

This ECG is from an elderly patient who had a routine pre-procedure ECG.

This ECG shows atrial fibrillation with LBBB (old) and large U waves. The cause was hypokalemia.

In the ECGquest archives, this ECG has been tagged with: - Hypotension Pacemaker spikes Wide QRS Ventricular pacemaker Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this altered and bradycardic patient? Repeat ECG after transvenous pacemaker

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia. This was the repeat ECG after placement of a transvenous pacemaker.

This ECG shows a very wide ventricular paced rhythm with widespread excessive discordant ST elevation. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Hypotension Bradycardia Irregular Nonspecific baseline artefact Extra P waves Peaked T waves Wide QRS Second degree AV block Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this altered and bradycardic patient?

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia.

This ECG shows an irregular rhythm due to second degree AV block with wide QRS and peaked T waves. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Discordant ST changes PR segment depression Wide QRS Myocarditis Pericarditis 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
A patient with chest pain and dynamic ST elevation

This ECG is from a woman in her 40s who presented with chest pain that had been waxing and waning over the past 24 hours. She had a history of renal failure on dialysis, hypertension, diabetes and a normal catheterisation a year ago. This was her initial ECG.

This ECG shows sinus tachycardia with nonspecific intraventricular delay, tall QRS and widespread PR segment depression. The ST segments are all discordant apart from V4 and V1. These changes were dynamic over serial ECGs. The cath was again normal. Echo showed a trace of pericardial effusion. The diagnosis was myopericarditis.

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