EKG Conduction abnormalities Part I
description
Transcript of EKG Conduction abnormalities Part I
![Page 1: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/1.jpg)
EKGConduction abnormalitiesPart I
Sandra Rodriguez, M.D.
![Page 2: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/2.jpg)
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).
![Page 3: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/3.jpg)
RBBB with ST-T abnormalities
![Page 4: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/4.jpg)
LBBB
QRS >120msecs. Terminal forces oriented leftward and
posteriorly. Terminal S wave in V1. Terminal R wave in I, aVL, V6.
![Page 5: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/5.jpg)
LBBB
![Page 6: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/6.jpg)
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
![Page 7: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/7.jpg)
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)
![Page 8: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/8.jpg)
LAFB
![Page 9: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/9.jpg)
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.
![Page 10: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/10.jpg)
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
![Page 11: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/11.jpg)
Bifascicular Blocks
RBBB plus either LAFB (common) or LPFB (uncommon)
Features of RBBB plus frontal plane features of the fascicular block (axis deviation, etc.)
![Page 12: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/12.jpg)
RBBB plus LAFB
![Page 13: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/13.jpg)
Method
Measurements Rhythm Analysis Conduction Analysis Waveform Description ECG Interpretation Comparison with Previous ECG (if any)
![Page 14: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/14.jpg)
Case 1
![Page 15: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/15.jpg)
Case 2
![Page 16: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/16.jpg)
Case 3
![Page 17: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/17.jpg)
Case 4
![Page 18: EKG Conduction abnormalities Part I](https://reader036.fdocuments.in/reader036/viewer/2022062322/56814c41550346895db94580/html5/thumbnails/18.jpg)
Case 5