ECG: Trifascicular Block

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ECG: Trifascicular Block

  1. 1. ECG OF THE WEEK<br />Prof.Dr . G.ELANGOVAN’S unit<br />Dr.M.Amudhan<br />
  2. 2. 73 year old male presented with c/o giddiness on & off<br />for past 1yr. <br /> chest pain past 2 days<br />Past history; not a k/c/o T2DM/SHT/IHD No other significant history<br />O/E pt concious ,oriented, afebrile.<br /> no pallor/icterus/cyanosis/clubbing/LN/pedal edema<br />Vitals; PR 84/min BP 150/90<br />Cvs: s1 s2 heard. No murmurs.<br />RS: nvbs heard, no added sounds,<br />Other systems also normal.<br />
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  6. 6. In this ECG<br />Rate – 80/min<br />Rhythm – sinus rhythm <br />P wave morphology – normal <br />PR interval – 0.24 s<br />QRS duration – 0.16 s, QRS axis: - 40 degrees <br />QRS morph. – RR’(M pattern) in V5,V6,aVL & L1 with secondary ST-T Changes Deep S waves in V1-V3 & L2 & L3<br />ST eievation in V1 – V3<br />
  7. 7. ECG<br />LBBB + First degree AV block<br /> POSSIBLE TRIFASCICULAR BLOCK<br /> WHICH HAS TO BE <br /> CONFIRMED ONLY BY<br />HIS BUNDLE ELECTROGRAM<br />
  8. 8. INTRA – VENTRICULAR CONDUCTION DEFECTS<br /><ul><li> Abnormality in conduction thru one or more divisions of intra ventricular conduction system distal to Bundle of His
  9. 9. Various conduction defects include:-</li></ul> RBBB<br /> LBBB<br /> LAFB<br /> LPFB<br /> Parietal Block<br />Peri Infarction Block <br />
  10. 10. Causes Of IVCD :-<br />Congenital ( RBBB in normal individuals )<br />IHD ( AMI / PMI / Coronary atherosclerosis )<br />Cardiomyopathy ( DCM / HCM )<br />Infiltrative Lesions ( Tumors / Chagas / Hypothyroidism / Amyloidosis )<br />Aortic stenosis ( LBBB )<br />Infective Endocarditis<br />Hyperkalemia<br />Cardiac Injury<br />Massive Pulmonary Embolism<br />Ventricular Hypertrophy<br />Myocarditis<br />
  11. 11. FASCICLE BLOCK - TYPES<br />Unifascicular Block<br /> LAFB<br /> LPFB<br /> RBBB<br />Bifascicular Block<br /> LBBB<br /> RBBB + LAFB<br /> RBBB + LPFB<br /> Definite Trifascicular Block<br /> Alternating BBB<br /> RBBB + alternating fascicular block<br /> RBBB + Mobitz type 2 second Deg AV Block<br /> LBBB + Mobitz type 2 second Deg AV Block<br /> Possible Trifascicular Block<br /> Complete AV Block with ventricular escape rhythm<br /> Any Bifascicular Block + 1ST or 2nd deg AV Block <br />
  12. 12. FASCICULAR BLOCKS<br />LAFB<br /><ul><li>LAD (-30 to -80 )
  13. 13. rS in L2,3,aVf
  14. 14. R in aVL ,L1
  15. 15. Absent q in V5 V6
  16. 16. RS in V5 V6</li></ul>LPFB<br /><ul><li>RAD ( +120 to + 180 )
  17. 17. rS in aVL , L1, V1 V2
  18. 18. R in L2 L3 aVF
  19. 19. Rs in V5 V6
  20. 20. QRS duration Normal
  21. 21. Increased QRS voltage
  22. 22. Increased VAT
  23. 23. Sec ST / T wave changes</li></li></ul><li>LBBB<br /><ul><li>1st degree:- q in V5 V6 disappears</li></ul> r in V1 V2 disappears<br /><ul><li> 2nd degree:- initial slurring of R wave in V5 V6</li></ul> QRS 0.10 – 0.12 sec<br /> VAT 0.06 – 0.09 sec<br /> Sec ST / T wave changes<br /><ul><li> 3rd degree :- wide slurred R wave in V5 V6</li></ul>RR’ / rSR’ / RSR’ pattern <br />QRS >0.12 sec<br />VAT > 0.09 sec<br />Sec ST / T wave changes<br />
  24. 24. THANK YOU<br />

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