This document discusses interventricular conduction delay and raised intracranial pressure as seen on electrocardiograms (ECGs). It defines interventricular conduction delay and lists various causes including fascicular blocks, bundle branch blocks, ventricular hypertrophy, dilatation, electrolyte abnormalities, toxins, pre-excitation, and arrhythmogenic cardiac conditions. It then discusses raised intracranial pressure and the associated ECG findings of widespread T-wave inversions, QT prolongation, and bradycardia as part of the Cushing reflex, indicating imminent brainstem herniation. Massive intracranial hemorrhages such as subarachnoid hemorrhage are the most common causes

1. Domina Petric, MD
ECG I

2. Interventricular conduction delay
Burns E. Interventricular Conduction Delay (April 16, 2017).
Retrieved from https://lifeinthefastlane.com/ecg-library/ivcd/
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3. Definition

4. Causes
Fascicular and bundle-branch blocks
Left anterior fascicular block
Left posterior fascicular block
Left bundle branch block
Right bundle branch block
Bifascicular block
Trifascicular block
Ventricular hypertrophy and dilatation
Left ventricular hypertrophy
Right ventricular hypertrophy
Biventricular enlargement
Dilated cardiomyopathy
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5. Causes
Electrolyte abnormalities
Hyperkalaemia
Toxins
Sodium-channel
blocker toxicity
(TCA overdose):
wide QRS +
positive R’ wave
in aVR.
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6. Causes
Pre-excitation
Wolff-
Parkinson-
White
syndrome:
wide QRS
+ delta waves.
Arrhythmogenic cardiac conditions
Brugada syndrome: localised QRS
widening in V1-V2 with RBBB
morphology.
Arrhythmogenic right ventricular
dysplasia (AVRD): localised QRS
widening in V1-V2 + epsilon
waves + variable signs of right
ventricular hypertrophy.
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7. Non-specific interventricular conduction delay
When other causes
are excluded!
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8. Intracranial haemorrhage
Burns E. Raised Intracranial Pressure (August 29, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/raised-intracranial-pressure/
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9. Raised intracranial pressure triad
Widespread giant T-wave inversions called
CEREBRAL T WAVES.
QT prolongation.
Bradycardia as the consequence of the Cushing
reflex-indicates imminent brainstem herniation.
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10. Other ECG features
•ST segment elevation or depression.
•Increased U wave amplitude.
•Other rhythm disturbances: sinus
tachycardia, junctional rhythms,
premature ventricular contractions,
atrial fibrillation.
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11. ECG changes due to raised ICP are most commonly seen with:
massive intracranial
haemorrhage such as
subarachnoid haemorrhage and
intraparenchymal haemorrhage
(haemorrhagic stroke).
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12. Subarachnoid haemorrhage
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Cerebral T waves
QT interval prolongation
Bradycardia

13. References
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