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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.
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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).

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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.

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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.
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