Prolonged and Bizarre Patterns of the QRS Complex - Electrocardiographic

Prolonged and Bizarre Patterns of the QRS Complex

Prolonged QRS Complex as a Result of Cardiac Hypertrophy or Dilatation

The QRS complex lasts as long as depolarization con-tinues to spread through the ventricles—that is, as long as part of the ventricles is depolarized and part is still polarized. Therefore, prolonged conduction of the impulse through the ventricles always causes a pro-longed QRS complex. Such prolongation often occurs when one or both ventricles are hypertrophied or dilated, owing to the longer pathway that the impulse must then travel. The normal QRS complex lasts 0.06 to 0.08 second, whereas in hypertrophy or dilatation of the left or right ventricle, the QRS complex may be prolonged to 0.09 to 0.12 second.

Prolonged QRS Complex Resulting from Purkinje System Blocks

When the Purkinje fibers are blocked, the cardiac impulse must then be conducted by the ventricular muscle instead of by way of the Purkinje system. This decreases the velocity of impulse conduction to about one third of normal. Therefore, if complete block of one of the bundle branches occurs, the duration of the QRS complex usually is increased to 0.14 second or greater.

In general, a QRS complex is considered to be abnormally long when it lasts more than 0.09 second; when it lasts more than 0.12 second, the prolongation is almost certainly caused by pathological block some-where in the ventricular conduction system, as shown by the electrocardiograms for bundle branch block in Figures 12–14 and 12–15.

Conditions That Cause Bizarre QRS Complexes

Bizarre patterns of the QRS complex most frequently are caused by two conditions: (1) destruction of cardiac muscle in various areas throughout the ventricular system, with replacement of this muscle by scar tissue, and (2) multiple small local blocks in the conduction of impulses at many points in the Purkinje system. As a result, cardiac impulse conduction becomes irregular, causing rapid shifts in voltages and axis deviations. This often causes double or even triple peaks in some of the electrocardiographic leads, such as those shown in Figure 12–14.