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Intraventricular conduction defects
  1. Milad Rashidbeygi1,
  2. Maryam Soleimannejad2
  1. 1Student Researcher Committee, Ilam University of Medical Sciences, Ilam, Iran
  2. 2Ilam University of Medical Sciences, Ilam, Iran
  1. Correspondence to Dr Milad Rashidbeygi, miladrashidbeygi{at}

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A 62-year-old woman with ischaemic heart disease reported having dyspnoea, chest pain in the left hemithorax, epigastric pain and nausea for 4 weeks. The patient's blood pressure was 150/90 mm Hg and ejection-fraction on echocardiography was 30–35%. An electrocardiogram showed a regular rhythm, with a widened QRS complex in all leads. There were notched R waves in V5, V6, aVL, II, III and aVF (figure 1). The small initial R waves in V1 and V2 were followed by deep S waves and wide S waves in left precordial leads (V5 and V6). The electrocardiogram showed characteristics of LBBB and RBBB simultaneously and a wide QRS complex; thus, we suspected an intraventricular conduction defect (IVCD). The ECG appearance of the IVCD was difficult to characterise, because IVCD is often the end result of a number of different pathophysiological processes rather than a discrete defect in the conduction system (as usually occurs with RBBB or LBBB).

Figure 1

The EKG of the patient.

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