Therefore left ventricular abnormalities cannot be reliably interpreted. Postconversion, sinus rhythm (SR) electrocardiogram (ECG). With a left bundle branch block left ventricular activation is no longer though the His-Purkinje system but results from direct myocardial activation coming from the right bundle and right ventricle. Therefore, abnormalities of the left ventricle can be interpreted on the ECG. With an IVCD, left ventricular activation still occurs through the normal His-Purkinje system, but conduction is slowed. When the complex is this wide, the IVCD is the result of a dilated cardiomyopathy (cardiomyopathic QRS complex). Therefore, the presence of septal forces means that widened QRS complex is the result of an intraventricular conduction delay (IVCD) and not a left bundle branch block.

With a left bundle branch block there is no septal activation occurring as the septal branch is no longer functional there are no septal forces seen. This accounts for the small septal R wave in lead V1 and small septal Q waves in leads I, aVL, and V5-V6. The first part of the ventricles to be activated is the septum, with the impulse going in a left to right direction. Septal activation results from an impulse conducted via the septal or medial branch that comes off of the left bundle. Most importantly there is a prominent septal R wave in lead V1 (→) which indicates normal septal activation. It can be seen in a variety of disorders such as myocarditis, cardiomyopathy, ventricular fibrosis, heart failure, a high potassium level, and following a heart attack. Also noted is prominent notching of the QRS complex in leads I, aVR, and V1-V6. Sometimes: Intraventricular conduction delay (ivcd) refers to a condition in which electrical conduction through the heart muscle is delayed or slowed. Concepts and types of IVCD Right bundle branch block. However, the QRS complex with a left bundle branch block is not usually this wide. Recognizing NSR Variations on NSR: Sinus arrhythmia Sinus bradycardia Sinus tachycardia. The QRS complex is wide (0.18 sec) and there is a morphology that resembles a left bundle branch block with a broad R wave in leads I and V6 (↑) and a deep S wave in lead V1 (←). The P waves are positive in leads I, II, aVF, and V4-V6 hence this is a normal sinus rhythm. There is a P wave (+) before each QRS complex with a stable PR interval (0.20 sec). Circulation - Circulation ECG Challenge Response! Regarding the 69 y/o man with a gout flare: Diagnosis-normal sinus rhythm, intraventricular conduction delay (cardiomyopathic QRS complex) There is a regular rhythm at a rate of 60 bpm.

Sinus rhythm ivcd