ecg: bifascicular block

ECG OF THE WEEKPROF.S.SUNDAR UNIT

ECG FINDINGRATE 150/MINRHYTHM AF/IRREGULARLY IRREGULARAXIS -80⁰/LEFT AXIS DEVIATIONP WAVE ABSENTQRS COMPLEX Q WAVE V1-V4 SECONDARY R WAVE WITH

SLURRING,WIDENING V1-V4 WIDENED TERMINAL S WAVE V5,6

S/O AWMI WITH RBBB rS pattern in II,III and aVF s/o LAFB A SINGLE VENTRICULAR ECTOPIC IS SEENST SEGMENT Elevation v1-v4 s/o ACUTE AWMIT WAVE SYMMETRICAL, DEEP INVERSION V1 -V4 S/O

PRIMARY CHANGES

DIAGNOSISACUTE ANTERIOR WALL MYOCARDIAL

INFARCTION WITH BI-FASCICULAR BLOCK(RBBB WITH LAFB)

ATRIAL FIBRILLATION

MI WITH BLOCKLBBB MAY BE MISINTERPRETED AS

RECENT ANTROSEPTAL MIMI MAY BE MASKED BY PRESENCE OF

LBBBRBBB NEITHER MIMICS NOT MASKS

MOST MI

MI WITH RBBBRBBB AFFECTS MID AND TERMINAL

PORTIONAL OF QRS COMPLEXSINGLE EXCEPTION- POSTERIOR BASAL MI

WHICH AFFECT TERMINALPART QRS AND MASKED BY RBBB

RBBB WITH ANTERIORWALL MIR WAVE DISAPPEAR IN V1-V4 AND

REPLACED BY QWAVE DUE TO INVOLMENT OF ANTERIORWALL OF RV

SECONDARY R WAVE PERSIST DUE TO DELAYED ACTIVATION OF UNINVOLVED FREEWALL OF RV

RBBB WITH INFERIORWALL MIMINIMAL INFLUENCE ON THE

ANTERIORWALL LEADS QWAVE AND ST SEGMENT CHANGES IN

INFERIORWALL LEADS ALONG WITH RBBB PATTERN IN PRECARDIAL LEADS

PROGNOSISMI WITH LAFB – MINIMAL ADVERSE

EFFECT ON PROGNOSISMI WITH LAFB WITH RBBB – POOR

PROGNOSIS MORTALITY 4-5TIMES INCREASED

MI WITH LPFB WITH RBBB – POOR PROGNOSIS MORTALITY 6-7 TIMES INCREASED

10 MI WILL DEVELOP BIFSCICULAR BLOCK

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