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Using the ‘ECG in 20 Seconds’ Approach:

Rate: 66

Rhythm: P waves present before each QRS

QRS: widened and RBBB pattern

Axis: Left axis

ST-T: Normal

PR/QT: Prolonged PR interval

This is a triphasicular block. A bit of a misnomer as only two fascicles are really blocked( left anterior and right bundle). The PR interval indicates disease however we are unclear as to where that disease is, is it in the Atrioventricular node or in the conduction system.

It explains the patient syncope. This patient needs a coronary care unit and cardiac monitoring. Electreophysiological studies may be done, however, patients presenting with syncope and this ECG, will get a pacemaker.

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