Question

Bundle Branch Blocks and Ventricular Rhythms both display a wide QRS complex. How are we able to differentiate between the two? Include an ECG example to help illustrate your point.

Discuss what could happen to the Left Atrium if the Mitral Valve were stenosed. How might this manifest on the ECG?

Answer 1

In Bundle branch block ,

• QRS duration greater than 120 milliseconds
• Absence of Q wave in leads 1 V5 and V6
• monomorphic R wave in 1 V5 and V6
• ST and T wave displaccement oppotite to the major deflection of the QRS complex

In ventricular Rhythm,

VT is frequently either in a right in a right bundle bracnch block unright in a right bundle branch block

If upward in lead V1 ,then VT is present in the followig situtuation,

A monophasic R or bisasic QR complex in V1

Ars complex in lead V6 favours VT

ARS or bunny ear pattern present in V1 with R peak

THe presence of anyy Q or QS wave in lead V6 favous VT

Slurred or notchhed downstroke of the S wave in V1 or V2 favours VT

The pressure buiid up of mitral valve stenosis result in enlargement of heart upper chamber Artium, The stretching and enlargement of heart left atrium may leads to this heart rhythm irregularity in which the upper chambers of heart beat chaitically and too quickly.

In patient with mitral stenosis the ECG can show signs of left atrial enlargement ( P wave duration in lead 2 greater than 0.12 seconds P wave axis of +45 to -30 marked terminals negetive component to the P wave inV1 and commonly atrial fibrilation

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