QRS Morphologies of Difficult Interpretation

  • Agnese Fioranelli
  • Enrico Paolini
  • Alessia Quaranta


ECG interpretation could be sometimes difficult and misleading.

We report here a case of left fascicular delays, called hemiblocks, that could possibly hide a structural heart disease or instead be completely meaningless.

In another example, we report Q waves in the inferior leads that could be pointless or consequence of a previous inferior myocardial infarction.

A simple clue to distinguish is to verticalize the heart axis through a deep inspiration; that could make Q waves’ disappearance in inferior leads.

Furthermore, a right bundle branch conduction pattern could sometimes implicate a differential diagnosis, between an incomplete RBBB and a Brugada syndrome.

In this chapter, we report three cases in which a correct ECG analysis may lead to the right diagnosis.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Agnese Fioranelli
    • 1
  • Enrico Paolini
    • 1
  • Alessia Quaranta
    • 1
  1. 1.Clinica di Cardiologia e AritmologiaUniversità Politecnica delle MarcheAnconaItaly

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