ekg conduction abnormalities part i sandra rodriguez, m.d
TRANSCRIPT
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EKGConduction abnormalitiesPart I
Sandra Rodriguez, M.D.
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RBBB
QRS > 120msec. Terminal forces oriented rightward and
anteriorly. rSR’ complex in V1. Terminal S waves in I, AVL, V6. Terminal R wave in aVR. Normal axis. ST-T should be negative in leads with
terminal R forces (secondary).
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RBBB with ST-T abnormalities
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LBBB
QRS >120msecs. Terminal forces oriented leftward and
posteriorly. Terminal S wave in V1. Terminal R wave in I, aVL, V6.
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LBBB
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Left Fascicular Anterior Block
QRS axis -45 to -90 degrees. QRS duration <120msecs unless RBBB. rS complexes in II, III, aVF. Small q wave in I, aVL. Poor R progression in leads V1-V3 and
deeper S waves in leads V5 and V6. R-peak time in lead aVL >0.04s, often
with slurred R wave downstroke
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Differential
Some cases of inferior MI with Qr complex in lead II (making lead II 'negative')
Inferior MI + LAFB in same patient (QS or qrS complex in lead II)
Some cases of LVH Some cases of LBBB Ostium primum ASD and
other endocardial cushion defects. Some cases of WPW syndrome (large negative delta wave in lead II)
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LAFB
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Left Posterior Fascicular Block
Right axis deviation in the frontal plane (usually > +100 degrees)
rS complex in lead I qR complexes in leads II, III, aVF, with R
in lead III > R in lead II QRS duration usually <0.12s unless
coexisting RBBB Very Rare defect.
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Differential
Many causes of right heart overload and pulmonary hypertension
High lateral wall MI with Qr or QS complex in leads I and aVL
Some cases of RBBB Some cases of WPW syndrome Children, teenagers, and some young
adults
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Bifascicular Blocks
RBBB plus either LAFB (common) or LPFB (uncommon)
Features of RBBB plus frontal plane features of the fascicular block (axis deviation, etc.)
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RBBB plus LAFB
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Method
Measurements Rhythm Analysis Conduction Analysis Waveform Description ECG Interpretation Comparison with Previous ECG (if any)
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Case 1
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Case 2
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Case 3
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Case 4
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Case 5