ecg: bifascicular block

12
ECG OF THE WEEK PROF.S.SUNDAR UNIT

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Page 1: ECG: Bifascicular Block

ECG OF THE WEEKPROF.S.SUNDAR UNIT

Page 2: ECG: Bifascicular Block
Page 3: ECG: Bifascicular Block

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

Page 4: ECG: Bifascicular Block
Page 5: ECG: Bifascicular Block

DIAGNOSISACUTE ANTERIOR WALL MYOCARDIAL

INFARCTION WITH BI-FASCICULAR BLOCK(RBBB WITH LAFB)

ATRIAL FIBRILLATION

Page 6: ECG: Bifascicular Block

MI WITH BLOCKLBBB MAY BE MISINTERPRETED AS

RECENT ANTROSEPTAL MIMI MAY BE MASKED BY PRESENCE OF

LBBBRBBB NEITHER MIMICS NOT MASKS

MOST MI

Page 7: ECG: Bifascicular Block

MI WITH RBBBRBBB AFFECTS MID AND TERMINAL

PORTIONAL OF QRS COMPLEXSINGLE EXCEPTION- POSTERIOR BASAL MI

WHICH AFFECT TERMINALPART QRS AND MASKED BY RBBB

Page 8: ECG: Bifascicular Block

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

Page 9: ECG: Bifascicular Block

RBBB WITH INFERIORWALL MIMINIMAL INFLUENCE ON THE

ANTERIORWALL LEADS QWAVE AND ST SEGMENT CHANGES IN

INFERIORWALL LEADS ALONG WITH RBBB PATTERN IN PRECARDIAL LEADS

Page 10: ECG: Bifascicular Block

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

Page 11: ECG: Bifascicular Block
Page 12: ECG: Bifascicular Block

THANK YOU