We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Challenges in Clinical Electrocardiography |

ST-Segment Elevation Followed by Progressive Widening of the QRS Complex

Daniel Czuriga, MD, PhD; Judit Barta, MD, PhD; Ildiko Rácz, MD; Istvan Édes, MD, PhD, DSc; Ferenc Györy, MD; Istvan Czuriga, MD, PhD; Zoltan Csanádi, MD, PhD
JAMA Intern Med. 2013;173(7):490. doi:10.1001/jamainternmed.2013.2959a.
Text Size: A A A
Published online


A 56-year-old physician was referred to our coronary care unit (CCU) for urgent coronary intervention. His epigastric pain had started 2 hours earlier, and the 12-lead electrocardiogram (ECG) recorded thereafter by the ambulance team in his home is shown in Figure 1A. During transport, he developed a wide QRS complex rhythm at 65 beats/min (Figure 1B), followed by episodes of ventricular fibrillation, which terminated with direct current shocks. On arrival at the CCU, he was conversant for a short period, but his condition then rapidly deteriorated and he became unconscious. Consecutive ECG recordings demonstrated further widening of the QRS complexes (Figure 1C and D).

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Initial 12-lead electrocardiogram recorded in the patient's home (A) and rhythm strip recordings of lead II during transportation (B) and shortly after arrival at the coronary care unit (C and D). Asterisks on panel A mark tented T waves with narrow bases. Note, that flattened P waves are discernable on panel B (arrows), but not on the following strips (C and D), which demonstrate progressive widening of the QRS complexes.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections