SECTION EDITORS: JEFFREY TABAS, MD; PAUL D. VAROSY, MD; GREGORY M. MARCUS, MD; NORA GOLDSCHLAGER, MD
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).
Czuriga D, Barta J, Rácz I, Édes I, Györy F, Czuriga I, Csanádi Z. ST-Segment Elevation Followed by Progressive Widening of the QRS Complex. JAMA Intern Med. 2013;173(7):490. doi:10.1001/jamainternmed.2013.2959a