ecg: bifascicular block
TRANSCRIPT
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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