Exam

QRS Complex

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QRS Complex, QRS Duration, Wide QRS, QRS Widening

  • See Also
  • Normal findings
  • Duration
  1. Limb leads (I, II, III): 0.05 to 0.10
  2. Precordial leads (V1 to V6): 0.06 to 0.12
  • Causes
  • Wide QRS or Prolonged QRS Complex (over 0.12)
  1. Abnormal interventricular conduction (e.g. Left Bundle Branch Block)
    1. See Bundle Branch Block
    2. Hypothermia
    3. Hyperkalemia
    4. Wolff-Parkinson-White Syndrome (WPW)
    5. Ventrciular ectopy
    6. Ventricular Tachycardia
  2. Medications (e.g. Toxin Ingestion or Overdose)
    1. Results from Sodium channel blockade
    2. Emergency management
      1. See Toxin Ingestion
      2. See Tricyclic Overdose
      3. Sodium Bicarbonate 1-2 amps IV push with repeat bolus until QRS narrows (adults)
    3. Causes
      1. Tricyclic Antidepressants
        1. Dry and sedated
      2. Cocaine
        1. Diaphoretic and agitated
      3. Diphenhydramine (Benadryl)
      4. Local anesthetics (esp. Bupivacaine)
      5. Antiarrhythmics (e.g. Quinidine, Flecainide)
      6. Propoxyphene (not available in U.S.)
      7. Digoxin Toxicity
        1. Associated with frequent PVCs and sagging ST depression
  • Causes
  • Low QRS amplitude (<5 mm in limb leads)
  • Causes
  • High QRS amplitude
  • References
  1. Mattu (2016) Crit Dec Emerg Med 30(8):16