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ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
ECG: RBBB with LAFB
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  • 1. THE ELECTROCARDIOGRAM Professor A. gowri shankar `s unit Presented by Dr. Ramesh unit -2
  • 2. History
    • Mr . Ranganathan 60/male,
    • a known hypertensive – 10yrs.
    • not a known DM / CAD.
    • no specific complaints.
  • 3. CASE PRESENTATION
  • 4.
    • Standardization and technical features are normal.
    • HR – 94/min
    • Rhythm – sinus.
    • P wave- normal
    • PR interval -(180 ms).
    • QRS DURATION- (0.13 s) .
    • mean QRS electrical axis (-70 to -60 ´ ).
    • QRS configuration – rSR pattern in lead V1 & slurring of S wave in V6.
    • qR pattern in lead 1 & aVL, `r S`pattern in lead II, III & aVF
    • QT interval-normal.
    • No abnormal Q waves / ST segment elevation
    ECG interpretation Name – Mr. Ranganathan, 60/m. Date - 19/6/11
  • 5. The Electrical System of the Heart AV Node Posterior Inferior Fascicle Anterior Superior Fascicle Septal Depolarization Fibers Purkinjie Fibers Inter- nodal Tracts Bundle of HIS Left Bundle Branch Right Bundle Branch SA Node
  • 6.
    • RBBB
    • The impulse is transmitted normally by left bundle to most of left ventricle
    • Impulse to part of interventricular septum and RV delayed, because of cell to cell depolarization
    • Slow impulse causes slower depolarization time.
    • LAFB
    •   Depolarization of left ventricle has to progress from interventricular septum, inferior wall, and posterior wall toward anterior and lateral walls
    • Gives rise to unopposed vector pointed superior and leftward
    • Changes net axis of ventricles toward left, producing left axis deviation
    • Electrical axis of ventricles found in left quadrant of hexaxial system, between –30˚ and –90˚.
  • 7.
    • A typical RBBB ECG
    • wide QRS complexes with a terminal R wave in lead V1 &
    • slurred S wave in lead V6.
    CRITERIA FOR RBBB CRITERIA FOR LAFB
    • The heart rhythm must originate above the ventricles (i.e. SA node, AVnode) to activate the conduction system at the correct point.
    • The QRS duration >100 ms (incomplete block) or >120 ms (complete block) [3]
    • terminal R wave in lead V1 (e.g. R, rR', rsR', rSR' or qR)
    • slurred S wave in leads I and V6
    • Abnormal left axis deviation ( usually bt –45° and –60°)
    • qR complex in the lateral limb leads (I and aVL) & rS pattern in the inferior leads (II, III, and aVF)
    • Delayed intrinsicoid deflection in lead aVL (> 0.045 s)
    • left anterior fascicular block together with right bundle branch block is indicative of ischaemia
  • 8.  
  • 9. Causes of RBBB Causes of LAFB
    • Normal variant.
    • Cor pulmunale.
    • Pulmonary embolism.
    • MI, CMP`S, HHD,CHD
    • Mechanical damage.
    • Lev`s disease.
    • Chronic hypertension
    • Aortic stenosis
    • Aortic root dilation
    • Dilated cardiomyopathy
    • Impairment of the cardiac electrical conduction system
    • Acute myocardial infarction
    • Lung diseases
    • Aging
    • Degenerative fibrotic disease
  • 10. Combination of RBBB & LAFH on ECG
    • Slurred S wave in lead I & V 6.
    • rabbit ear pattern in V 1 of RBBB w/delayed QRS complex of 0.12 sec or more
    • Left axis deviation & rS waves in lead III are typical of LAFB
  • 11. DISCUSSION
    • LAFB is far more common than LPFB why ?
    • The traditional explanations are 
    • Anterior fascicle is relatively sub epicardial in location
    • It is a  long and thin  structure prone to damage easily
    • Exposed to the mechanical   stress of   LVOT
    • Anterior fascicle has  only a single blood supply(LAD)
    • Clinical Significance of LAFB
      • seen in approximately 4% of acute MI
      • It is the most common type of intraventricular conduction defect seen in acute anterior MI, and the left anterior descending artery is usually the culprit vessel.
      • It can be seen with acute inferior wall MI .
  • 12.  

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