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ECG Quiz

Description: https://johnsonfrancis.org/profession... What are the salient findings in this ECG and their interpretation? If this patient had pulmonary stenosis, what would be estimated right ventricular systolic pressure? Can you locate the beats which will be associated with cannon waves and those with soft first heart sound? ECG shows complete heart block and right ventricular hypertrophy. There is significant variation in the PP interval from 720 to 960 ms, indicating exaggerated sinus arrhythmia. RR interval is rather fixed at around 1120 ms. PR interval is varying, overall indicating complete heart block. Right axis deviation of QRS complexes (rS in I, aVL) with tall R waves in V1 and deep S in V5, V6 indicate right ventricular hypertrophy. Tall, peaked P waves in inferior leads indicate associated right atrial overload. R wave height in V1 is 23 mm. Using the formula 5 x R wave height in V1 for pulmonary stenosis, estimated right ventricular systolic pressure would come to 115 mm Hg. Actually, this was not a case of isolated pulmonary stenosis. Double outlet right ventricle with ventricular septal defect and severe pulmonary stenosis was noted on echocardiogram. Beats with long PR interval (3rd, 4th and last in the rhythm strip) will have soft first heart sound. Beats in which P waves fall on the ST segment or anywhere between R and T – electrical systole of the ventricles, will have cannon waves as atrial contraction at that time will find the AV valves in a closed position.