Tall R waves across the precordial leads.

We here present a case of tall R waves in V1-V3, with normal R waves in V4-V6, due to a rare clinical entity. The differential diagnosis of such condition is reviewed. ECG clues are provided to guide the diagnosis. A simple diagnostic test is ordered to confirm the diagnosis.

ECG of the Month:Changing Morphology of a Wide-QRS Tachycardia.

An obese 49-year-old man with a history of systemic arterial hypertension, diabetes mellitus, dyslipidemia, three myocardial infarcts, an ischemic cardiomyopathy, a four-vessel coronary artery bypass operation 7 years earlier, and implantation of a cardioverter-defibrillator 2 years earlier comes to the hospital with palpitations and dyspnea. An ECG is recorded.

What is the Etiology of the Tall Initial R Wave in V1-V2?

We present an electrocardiogram that may be passed on as showing a simple right bundle branch block, but for the vigilant interpreter, a posterior infarction could be easily gleaned from the presence of a tall initial R wave in V1-V2.

Tombstone Sign in an Inferior Wall Myocardial Infarction.

A 62-year-old white patient presents with markedly ischemic electrocardiogram, notable for Tombstone sign.

Unusual Disappearance of Inferior Q Waves in an Elderly Man.

In a patient with an old inferior myocardial infarct, the Q waves disappear when he develops left anterior fascicular block.

Arrhythmia With an Exercise Test.

A 64-year-old man with known coronary disease presented to the hospital with sinus bradycardia, chest pain, and normal cardiac enzymes. During an exercise stress test he developed ventricular fibrillation that spontaneously resolved.

Chest and Back Pain.

A man with an acute anterolateral myocardial infarct had electrocardiographic features suggesting triple vessel coronary arterial disease and infarct-related regional pericarditis.

Failure of Atrioventricular Conduction.

In a 27-year-old man the electrocardiogram suggests increased vagal tone, and not intrinsic atrioventricular nodal disease, as the cause of transient atrioventricular block.

Electrocardiogram in a 75-Year-Old Woman With Left-Sided Chest Pain.

In a 75-year-old woman with left-sided chest pain and an abnormal electrocardiogram the etiology is not cardiac.

A Wide Wide QRS.

This case report describes a patient in their 70s with shortness of breath and generalized weakness and a history of coronary artery bypass surgery, ischemic cardiomyopathy, a dual-chamber defibrillator, paroxysmal atrial fibrillation, and kidney failure while undergoing hemodialysis.

Treadmill Stress Test in a 56-Year-Old Man.

Several findings on an exercise electrocardiogram predicted left main and/or 3-vessel coronary arterial disease, which was confirmed by coronary arteriography, and the 56-year-old man underwent a multivessel coronary arterial bypass operation the following day.

Changes in Mental Status and Dyspnea Followed by Pulseless Electrical Activity.

Following back surgery a man developed extensive pulmonary emboli that proved fatal.

Wide-QRS Tachycardia in an 89-Year-Old Woman With an ICD.

An elderly woman had ventricular tachycardia, and her defibrillator failed to discharge. Intravenously administered amiodarone returned her to sinus rhythm.

New Onset Palpitations, Chest Pain, Dyspnea, and Diaphoresis in a 65-Year-Old Woman.

A woman with the new onset of cardiac symptoms was in atrial fibrillation with a wide QRS complex that was not typical of bundle branch block. After electrical cardioversion, a short PR interval and delta waves indicated the presence of an accessory atrioventricular pathway. This left lateral atrioventricular bypass tract was subsequently ablated.

Chest Pain and Electrocardiographic Changes.

A 58-year-old man with his first episode of chest pain had an acute anterior myocardial infarct. After balloon angioplasty and stenting of a completely occluded left anterior descending coronary artery, the anterolateral ST-T changes had largely resolved.

Electrocardiogram Before Surgery in a 21-Year-Old Woman.

A routine preoperative electrocardiogram was read by the computer as arm-lead reversal, but several features indicated that the patient had situs inversus totalis.

Epigastric Pain, Vomiting, and Cardiac Arrhythmias.

A woman with epigastric pain and nausea had atrioventricular block confined to episodes of vomiting.

Unusual Tachycardia After Cocaine Use.

This case report presents the electrocardiogram findings of a patient in their 20s with severe midsternal chest pain of several hours' duration after cocaine use.