Download Diffuse Intraventricular Conduction Delay (DIVCD)

VOLUME
24, No. 2 SUMMER 1992
INTERESTINGELECTROCARDIOGRAM
Interesting Electrocardiogram
DIFFUSE INTRAVENTRICULAR CONDUCTION DELAY (DIVCD)
M. Iren~ Ferrer, MD
There are two electrocardiograms illustrating this con- The defect occurs in severe myocarditis, extensive infildition of diffuse intraventricular conduction delay trative myocardial disease, and chronic diffuse myocar(DIVCD). The first is on a 37 year old female taken dial diseases such as rheumatic heart disease or
during a pre-operative evaluation for inguinal atherosclerotic heart disease, particularly in the preshernioghaph~ There is a slightly prolonged PR (0.217 ence of ventricular aneurysms. It may be seen with
sec.) and a QRS widened to 0.110 sec. The second record severe hypoxia, hypothermia, hyperkalemia, and exhas a wide QRS (0.119 sec.) and abnormal Q waves in cessive doses of quinidine or procainamide.
the inferior-lateral leads and was taken on a 68 year old
male admitted for gall bladder surgery.
The insurance evaluation of DIVCD has not been studied at length. First of all the incidence of finding DIVCD
The evaluation of IV conduction defects in general has in insurance applicants has until now been unknown.
centered about the meaning of blocks in the bundle
In a study of 19,734 electocardiograms on applicants to
branches and very little has been reported about the
the Metropolitan Life Insurance Compan},, the frediffuse form of IVCD. Blocks in the fascicles and main quency of DIVCD was low, 18 cases (or 0.09%) and no
bundle branches are now fairly well understood. When 5 year deaths were found. Obviously if there are assothe HIS and main bundle system is fully operative and ciated abnormalities in the electrocardiogram, as in
normal there can still be a delay in the myofibrillar both these tracings one of which had first degree AV
structures themselves, i.e. out in the myocardium, block and the other signs of myocardial infarction when the electrical impulse has traveled normally over there is no real problem in accepting the DIVCD as
the specialized AV tissues. Of course, the disturbance important and even to add a further rating to that of the
must be fairly widespread throughout the myocardium other impairments. With a solitary finding- only a wide
to prolong the QRS.
QRS - one must look for hidden disease (in the absence,
of course, of drug effects). It is probably correct to say
The diagnostic criterion is an abnormally wide QRS that even as a solitary finding it cannot be ignored.
complex whose contour is the same as during normal
intraventricular conduction. No evidence of bundle
branch block or fascicular block is seen.
Consultant in Cardiology, Metropolitan Life Insurance Company. Professor Emeritus of Clinical Medicine, College of Physicians and Surgeons,
Columbia University. Consultant Electrocardiographer, Presbyterian
Hospital, Columbia Presbyterian Medical Center, New York, New
York.
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JOURNAL OF INSURANCEMEDICINE
VOLUME 24, No. 2 SUMMER 1992
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No. 2 SUMMER 1992
INTERESTINGELECTROCARDIOGRAM