ECG Blog #89 (Basic Concepts-2) – Intervals (PR-QR. We will discuss distinction between RBBB,. For our purposes here - it suffices to recognize: i) IF and when the QRS complex is wide and ii) When the QRS is wide - WHY is it wide ( conduction NOTE: We do not discuss the intricacies of distinguishing between RBBB vsīranch Block ) in this post - nor do we discuss differentiation between BBB vs more One ventricle is much slower ( smaller green arrows ). Reason the QRS complex is wide is BBB ( Bundle Branch Block ). Is preceded by an upright P wave with fixed PR interval in Tracing A ( in Figure-7 ) - There is Sinus Rhythm, because each QRS. This results in much faster conduction of the impulse to the The reason the PR interval is shorter-than-expected (ie, less than 0.12 second ) with WPW - is that a special conduction pathway exists that bypasses the AV Node. Physiologically - most of the time that makes up the normalĠ.12-to-0.20 second duration of the PR interval is spent trying to get through the AV Node. A wide QRS complex refers to a QRS complex duration 120 ms. Non-specific Intraventricular Conduction Delay (IVCD) IVCD does not meet criteria for other diagnoses Medications (e.g. Principal clinical entity in which this happens is WPW ( Wolff- Parkinson- White ) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. May also be too short (ie, less than 0.12 second in duration ). In addition to an upper normal limit for PR. That said - We focus attention in this Blog post on ECG 
BOTTOM Line: Be Aware that ECGĪssessment of a pediatric patient is different than in an adult. Interval duration may therefore be somewhat less Through the smaller heart of a young child compared to the time for the impulse
As a result - it may take less time for the impulse to travel Point #3: Regardless of whatever system you favor for your systematic interpretation - LookĪt an early phase in the process ( See below ).Ĭhildren have smaller hearts than adults.There are no reciprocal ST changes and the patient is a young adult withĪn early STEMI might need to be strongly considered if the same ECG was obtained from an older patient with worrisome chest pain. For example - even marked concave up ST elevation is unlikely to indicate infarction IF This is the time to integrate the ECG findings you noted into context with the clinical scenario. Point #2: It is only after you complete DescriptiveĪnalysis - that you should formulate your Clinical Impression.MAY BE NORMAL VARIANT WITH QRS WIDENING WITH REPOLARIZATION ABNORMALITY. Instead - one simply makes note of the ECG findings that RVE RSR LBBB ILBBB AFB PFB BIFBI BIFB2 BIFB TRIFB IVCD BO - IVCD RVH RVH. Point #1: Start with Descriptive Analysis - in which you sequentially assess the followingĦ Parameters : i) Rate ii) Rhythm iii) Intervals iv) Axis v) Chamber.
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