Case 60: An 82-Year-Old Man in the Cardiac Surgical ICU
History
Diagnosis
History
An 82-year-old man is in the cardiac surgical ICU, one day after a triple aorto-coronary bypass:
Diagnosis
- Sinus rhythm, 97/min
- Bifascicular block – Right bundle branch block and left posterior fascicular block
- ST and T wave abnormality, consider inferior ischemia
- ST abnormality, consider anterolateral ischemia
In this patient with bifascicular block, the QRS forces are directed first to the left and superiorly, then to the right and inferiorly. The cable/electrode of lead V2 was incorrectly placed high on the left sternal border, which explains why the QRS pattern in V2 is similar to that in aVL. Lead V2 misplacement is very common, particularly in very busy areas such as the ICU.
ECG ID: E582