Junctional rhythm, inferior and anterior wall infarction
Click on the image for an enlarged view
QS complexes in inferior and anterior leads indicate old anterior and inferior wall infarction. It is a slow rhythm with no P waves preceding the QRS complexes, a feature of junctional rhythm. Notch at the proximal region of the ST segment is suggestive of retrograde P waves. Generalised flattening of T waves can occur due to hypokalemia or hypothyroidism. Absence of significant ST – T changes make digoxin less likely as the causative agent for the brady rhythm. Limbs somewhat meet the criteria for low voltage (less than 5 mm amplitude in limb leads), while the chest leads do not meet the criteria (less than 10 mm amplitude in all leads).