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 31864

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! 31813

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? 31724

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 31386

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. 31296

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 30488

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? 30420

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? 30426

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 30230

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 30441

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 30227

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 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. 30033

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? 30008

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). 29698

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 29569

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: - 12-Lead Irregular Normal rate Tall U waves Wide QRS Atrial fibrillation Hypokalemia 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? 29359

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 12-Lead Nonspecific baseline artefact Bradycardia Extra P waves Irregular Peaked T waves Wide QRS Second degree AV block Hyperkalemia Dr Smith's ECG Blog CC BY-NC
What will you do for this altered and bradycardic patient? 29169

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: - Hypotension 12-Lead Pacemaker spikes Wide QRS Ventricular pacemaker Hyperkalemia Dr Smith's ECG Blog CC BY-NC
What will you do for this altered and bradycardic patient? Repeat ECG after transvenous pacemaker 29338

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: - Chest pain 12-Lead Concordant ST elevation Discordant ST changes PR segment depression Wide QRS Myocarditis Pericarditis Dr Smith's ECG Blog CC BY-NC
A patient with chest pain and dynamic ST elevation 29122

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.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Long PR Long QT Wide QRS Hyperkalemia Hypocalcaemia ECG of the Week CC-BY-NC-SA
ECG of the Week – 31st December 2018 – Interpretation 29024

This ECG is from a woman in her 30s who presented with cramping following thyroid surgery.

This ECG shows prolonged QT due to long ST segment, no U waves, but also a prolonged QRS and PR. There was hypocalcemia, mild hyperkalemia and hypermagnesemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Regular Tachycardia Wide QRS Wide complex tachycardia Toxicology / Overdose Dr Smith's ECG Blog CC BY-NC
Wide-complex tachycardia: VT, aberrant, or “other?” 28842

This ECG is from an older woman who presented with dyspnoea, diaphoresis and chest pressure. She had a background of paroxysmal AF for which she was on flecainide.

This ECG shows a regular wide complex tachycardia with possible flutter waves. There was no response to adenosine. The patient was electrically cardioverted. The cause was thought to be flecainide toxicity.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Delta wave Wide QRS Wolff Parkinson White syndrome ECG Interpretation CC-BY-NC-SA
ECG Blog #157 (RBBB – LBBB- WPW – RVH – ST depression) 28790

This ECG is from a man in his 30s who presented with chest pain on a background of smoking.

This ECG shows wide QRS complexes with delta waves due to Wolff Parkinson White syndrome. Cardiac catheterisation was normal.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Wandering baseline Excessive discordant ST depression. Excessive discordant ST elevation Pacemaker spikes Regular Tachycardia Wide QRS Ventricular pacemaker Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Can you see through this wide complex rhythm? 28777

This ECG is from a man in his 70s who presented with intermittent dyspnoea and chest pain over the past 2 weeks. He had a history of a pacemaker, heart failure, aortic stenosis, diabetes, hypertension, stroke, ischemic heart disease, chronic kidney disease and peripheral vascular disease. This was his initial ECG.

This ECG shows a wide complex tachycardia with ventricular pacing. The excessively discordant ST changes in V4-6 and aVR suggested diffuse subendocardial ischemia. He was found to have severe three vessel disease and a proximal left circumflex stenosis was stented.

In the ECGquest archives, this ECG has been tagged with: - Syncope 12-Lead Left Axis Deviation Long PR Normal rate RSR' Wide QRS First degree AV block LAFB RBBB Trifascicular block ECG of the Week CC-BY-NC-SA
ECG of the Week – 26th November 2018 – Interpretation 28721

This ECG is from a man in his 60s who presented after an episode of syncope.

This ECG shows bifascicular block (RBBB + LAFB) with a first degree AV block. He underwent pacemaker insertion.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ECG of the Week CC-BY-NC-SA
ECG of the Week – 5th November 2018 – Interpretation 27729

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

This ECG shows LBBB and occasional PVCs with discordant changes that do not meet Sgarbossa criteria. The patient self-discharged against advice before an echo could be completed for possible LVH.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Limb leads Concordant ST elevation Inferior ST depression Wide QRS Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died. 27556

This ECG is from an elderly male who presented with chest pain. He has a pacemaker. This was his first prehospital ECG.

This ECG shows ventricular paced rhythm with concordant STE in aVR and concordant ST depression in II, III, aVF. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Absent P waves Bradycardia Irregular Normal Axis RSR' Wide QRS Atrial fibrillation ECG of the Week CC-BY-NC-SA
ECG of the Week – 1st October 2018 – Interpretation 27558

This ECG is from a man in his 80s who presented feeling generally unwell and nauseous, on a background of chronic atrial fibrillation, diabetes and hypertension.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Chest leads Concordant ST elevation Excessive discordant ST elevation Wide QRS Ventricular pacemaker Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died. 27755

This ECG is from an elderly male who presented with chest pain. He has a pacemaker. This was his second prehospital ECG.

This ECG shows ventricular paced rhythm with excessive discordant ST elevation in V3 as well as concordant ST elevation in V2 and V4. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.

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