Question 15.4

Angoff score
6.45
Highest mark
9.25
Pass rate
??
Other SAQs in this topic:
Other SAQs in this paper:

An 80-year-old patient presents with syncope.
Interpret this ECG. (1.5 marks)

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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 what used to be called "trifascicular block". 

The abnormalities, in a structure of sorts:

  • The rate and rhythm are sinus bradycardia
  • The P waves look normal
  • The PR interval is prolonged
  • There is a left axis deviation
  • The QRS complexes are of a RBBB morphology. The QRS is prolonged, there is a slurred S wave in V6, and RSR pattern in V1. The T waves are appropriately inverted in leads V1-V3.
  • There are small Q waves and tall R waves in Lead I and aVL; as well as small R waves and deep S waves in Lead II, Lead III and aVF. So, this is also a left anterior fascicle block

References

2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

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