Question 15.3

College answer

Syllabus topic/section:

2.1.4 Cardiovascular Intensive Care /Interpretation of the electrocardiogram: L1

Discussion:  

Overall answered well. Candidates are encouraged to practice interpreting ECGs of common or potentially life-threatening conditions where ECGs are key to diagnosis.

Discussion

This ECG demonstrates right heart strain.

The abnormalities, in a structure of sorts:

• The rate and rhythm are sinus tachycardia
• The P waves look normal
• The PR interval looks normal
• There is a left axis deviation
• The QRS complexes are of a RBBB morphology. The QRS seems to be slightly prolonged, although one cannot see the littlest squares; there is a wide slurred S wave in V6, and one can convince oneself of an RSR pattern in V3. 
• There are ST segment changes in V1-V3, which look like ST elevation and T wave inversion, and there is some T wave inversion in leads II, III and aVF. 
• There is some of an S1 Q3 T3 pattern - the S wave is sort of deep in lead I, and the T wave is inverted in Lead III, but one cannot convince oneself of a Q wave in lead III

One would have to say "pulmonary embolism" if one had to come up with one short punchy half-mark diagnosis.