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. ![]() Also noted is prominent notching of the QRS complex in leads I, aVR, and V1-V6. However, the QRS complex with a left bundle branch block is not usually this wide. ![]() 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.
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