Differential Diagnoses: must know causes of right axis deviation and wide QRS complexes

ECG Weekly Workout with Dr. Amal Mattu


A 30-year-old man is pulled over by police for speeding. He begins feeling nauseous and has multiple episodes of vomiting. During transport to the emergency department by EMS he is noted to have a generalized seizure and found to be in ventricular fibrillation. The patient is defibrillated successfully, and the following ECG is obtained on arrival to the ED:

Before watching the video, look closely at this ECG and ask yourself:

  1. What is your differential diagnosis for wide QRS complexes?
  2. What is your differential for right axis deviation?
  3. What is the most likely diagnosis and treatment of choice?
  4. Are there any medications you would avoid during treatment?