ECG Clinic


Am Heart Hosp J. 2011;9(2):112–3


Acute Pericarditis Superimposed on Right Bundle Branch Block, Posterior Fascicular Block, and Interatrial Block


David H Spodick, MD, DSc, FACC


An electrocardiogram of a 72-year-old man who developed acute respirophasic pain in the left and central anterior chest plus fever (103 °F) (Figure 1). There are ubiquitous ST segment deviations (labeled ‘J’), right axis deviation (approximately 160 °), indicating posterior fascicular block right bundle branch block, late intrinsic deflection (in V1) with virtual Q waves in lead I and a


Figure 1: Two Column St Vincent – SVH (01-01-02)


Virtual Q I J PR5 V2 I I J PR5 I I I aVF J V3 V6 J Q aVL J J V5 P+E P(IAB) aVR V1


definite Q wave in lead II as well as a decrease in r wave voltage from V5 to V6 (V6 resembles lead I). The patient had a typical triphasic pericardial rub, a small pericardial effusion and a small left pleural effusion. The electrocardiogram is classic for acute pericarditis because the PR segments (PRs) are deviated as well as the J points (ST takeoffs). The suggested Q waves in leads I and II are


Not confirmed P(IAB) V4


PR5


I I


Device: PWT2225


Speed: 25 mm/sec


Limb: 10 mm/mV


Chest: 10 mm/mV


F 60~ 0.5-40 Hz W PH090A CLP?


• Medical Service, St Vincent Hospital, Worcester


• Correspondence: David H Spodick, MD, DSc, FACC, Medical Service, St Vincent Hospital, 123 Summer Street, Worcester, MA 01608. E: david.spodick@stvincenthospital.com


112 Acute Pericarditis Superimposed on Right Bundle Branch Block, Posterior Fascicular Block, and Interatrial Block Winter 2011


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68