ECG of the week 111

Interpret the ECG

ECG Case 111

·71yr old male who

·Presented with several episodes of ischemic sounding

·Chest pain

·Background of known ischemic cardiac disease



  • Mean rate 66 bpm


  • Sinus rhythm
  • Unifocal PVCs


  • Normal


  • PR – Normal (~200ms)
  • QRS – Prolonged (120-130 ms)
  • QT – 410ms (QTc Bazett 470 ms)


  • QRS fragmentation 
    • Best seen leads V2-3
    • Lead V2 rsr’s’r”s” pattern
    • Lead V3 rsr’s’ pattern
  • T wave inversion leads V4-5
  • ST elevation leads aVR and aVL (< 1mm)<1mm font=””>
  • ST depression leads II, III, aVF


  • ST and T wave changes
    • Likely ACS given history 
    • Needs serial ECGs and comparison with prior ECGs
  • QRS Fragmentation
    • Caused by abnormal ventricular repolarisation
    • Due to myocardial scarring, fibrosis or ischaemia


by Dr John Larkin