Sinus rhythm with a new wide complex QRS

This is another case written by Pendell Meyers, a G2 at Stony Brook. As I mentioned before, Pendell will be helping to edit and write the blog.CaseA middle aged female with type 2 diabetes presented to her endocrinologist for a regularly scheduled follow up appointment for diabetes management. Her history included ischemic cardiomyopathy (CM) with placement of an AICD, CAD s/p CABG, and recent elective LAD stent complicated by ischemic colitis requiring hemicolectomy and colostomy.During the appointment she complained of several days of off and on dizziness and bilateral leg weakness, and she also told the endocrinologist that she felt as though " life is not worth living anymore " due to multiple concurrent psychosocial stressors as well as her medical issues. Her endocrinologist sent her immediately to the ED for psychiatric evaluation. On the way to the ED she experienced several episodes of left sided chest and abdominal pain described as brief stabbing pains.On initial exam in the ED she complained of sharp intermittent chest and abdominal pains, increased weakness from baseline, and continued anxiety and tearfulness concerning her overall quality of life given her recent illnesses.Here is her initial ECG:What is your interpretation?There is sinus rhythm at approximately 75 bpm with prolonged PR interval. The QRS complex is wide, approximately 160ms. There are ST deviations which appear appropriate and proportional to the abnormal QRS.To some long-time readers, the ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs