Idioventricular Rhythm Mime of RVH
Report:
Idioventricular (?fascicular) rhythm 57/min
Giant T wave inversion
Prolonged QT interval
Comment:
The QRS morphology suggests, superficially, RVH. In V1, however, it is not a true qR complex – there is a small primary R wave as well: it’s an rsR’ complex. In view of the known preceding chronic LBBB, it probably originates from the distal, unblocked LBBB, maybe its posterior division (with LAHB axis in the frontal leads).
The T waves and their long QT interval attest to a preceding cerebral event, syncope or worse (actually the latter – she never woke up). This is consistent with arresting while waiting for a pacemaker.
Below (Fig 59a) is her junctional rhythm the next day, looking like an incomplete LBBB with old anterior MI. The striking repolarisation changes have resolved.
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