Risk stratification and medical management of NSTE-ACS (UA/NSTEMI ) Dr Sajeer K T.
Nonischemic regional wall motion abnormality - LBBB Dr sajeer K T Senior Resident, Dept. of...
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Transcript of Nonischemic regional wall motion abnormality - LBBB Dr sajeer K T Senior Resident, Dept. of...
Nonischemic regional wall motion abnormality - LBBB
Dr sajeer K TSenior Resident,
Dept. of Cardiology,Medical College, Calicut
Normal spread of electrical activity in the heart
Depolarization of the ventricular muscle starts at the left side of the interventricular septum and moves first to the right across the midportion of the septum
Normally conduction down the left bundle precedes that down the right bundle by 10 to 20 ms
Normal initial activation of the heart is in the proximal mid septum on the left ventricular side
Initial septal activation is reversed.
LBBB
Right side of the ventricular septum is initially activated
Right septal activation before activation of the body of the left ventricle
Initial right to left movement of the ventricular septum (anterior to posterior)
Interrelation between right and left ventricular events in normal subjects and LBBB
Normal M-mode Echo
Interventricular septal motion in LBBB and the relation to dynamic interventricular asynchrony.
Circulation Vol 79, No 4, April 1989
High amplitude oscillations of the IVS
Abnormal interventricular septal oscillations
LV –RV Asynchrony
- Contraction- Ejection- End systole- End diastole
M-mode echocardiogram recorded in a patient with a left bundle branch block shows an early systolic downward motion of the ventricular septum (arrows).
LBBB v/s Ejection fraction
Regional ejection fractions of apical and lateral segments similar in normal (NL) and left bundle branch block (LBBB) groups. Septal ejection fraction decreased in LBBB patients (40+16%) compared with normal subjects (67±+7%).
Circulation Vol 79, No 4, April 1989
Mechanism for global cardiac abnormalitiesin isolated left bundle branch block
Altered Ventricular Activation
Delayed LV Contraction
LV-RV Asynchrony
Abnormal septal Motion
Abnormal LV Septal EF
Decreased LV diastolic time
Nonischemic Regional Wall Motion Abnormality
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