Old inferior/posterior infarction? with first degree and bifasicular block

Commentary by Matthew Schumaecker
EKG edited and recorded by Dr. M. Rosengarten, MUHC, 1997

The rhythm is sinus rhythm at 50/minute. The PR interval is 280ms. The QRS interval duration is about 200 milliseconds. There is an M shaped QRS complex in leads V1 to V4. In addition there are deep and slurred S waves in leads I, aVL, V5 and V6. There are also prominent S waves proceeded by very small r waves in II, III and aVF as well as a left axis deviation of first part of the QRS. Together, these phenomena indicate the presence of a trifasicular block, first degree block, right bundle branch and left anterior hemiblock..

The ST-segment depression in leads V1-V4 and inverted T waves which are probably related to the conduction disturbance. The tiny R waves in II, III and aVF and the dominant R in V1 could also suggest an old inferior/true posterior myocardial infarction.