Recognition
- • QRS ≥120 ms
- • Broad notched 'M' R wave in I, aVL, V5–V6
- • Deep QS in V1
- • Discordant ST/T (opposite to QRS direction)
Key findings
- • No septal Q in I, V5, V6
- • Left axis common
Clinical importance
- • Obscures STEMI diagnosis — use Sgarbossa / modified Sgarbossa
- • Often structural heart disease — echo indicated
Management pearls
- • Investigate cause (IHD, cardiomyopathy, AS)
- • Consider CRT if EF ≤35 + symptomatic HF + QRS ≥130 ms
