Voir la suite de cet article sur Cursus ECG
Patient
Asymptomatic 57-year-old man with no prior history, referred to his cardiologist by his attending physician for bradycardia diagnosed by pulse measurement; performing of an electrocardiogram in this setting;
Trace
Alternation between two QRS complexes:
1) a first complex of sinus origin (positive P wave in leads I, II, V5, V6 and negative in aVR) with normal PR interval (120 ms); wide QRS with right bundle branch block pattern;
2) a non-fragmented, premature ventricular complex, left delay; this electrocardiogram thus reveals a ventricular bigeminy with alternation between a conducted QRS and a monomorphic premature ventricular complex with fixed coupling interval;
Exergue
Pulse measurement in a patient with premature complexes may give a false impression of bradycardia (bradysphygmia) or reveal an irregularity in the rhythm and amplitude of the felt beats (amplitude increased on the cycle following the post-extrasystolic pause due to increased diastolic time).
Patients with premature ventricular complexes may be perfectly asymptomatic, the diagnosis being made at pulse taking with evidence of irregularity and premature beating.