1. ECG OF THE WEEK Prof.Dr . G.ELANGOVAN’S unit Dr.M.Amudhan

2. 73 year old male presented with c/o giddiness on & off for past 1yr. chest pain past 2 days Past history; not a k/c/o T2DM/SHT/IHD No other significant history O/E pt concious ,oriented, afebrile. no pallor/icterus/cyanosis/clubbing/LN/pedal edema Vitals; PR 84/min BP 150/90 Cvs: s1 s2 heard. No murmurs. RS: nvbs heard, no added sounds, Other systems also normal.

6. In this ECG Rate – 80/min Rhythm – sinus rhythm P wave morphology – normal PR interval – 0.24 s QRS duration – 0.16 s, QRS axis: - 40 degrees QRS morph. – RR’(M pattern) in V5,V6,aVL & L1 with secondary ST-T Changes Deep S waves in V1-V3 & L2 & L3 ST eievation in V1 – V3

7. ECG LBBB + First degree AV block POSSIBLE TRIFASCICULAR BLOCK WHICH HAS TO BE CONFIRMED ONLY BY HIS BUNDLE ELECTROGRAM

9. Various conduction defects include:- RBBB LBBB LAFB LPFB Parietal Block Peri Infarction Block

10. Causes Of IVCD :- Congenital ( RBBB in normal individuals ) IHD ( AMI / PMI / Coronary atherosclerosis ) Cardiomyopathy ( DCM / HCM ) Infiltrative Lesions ( Tumors / Chagas / Hypothyroidism / Amyloidosis ) Aortic stenosis ( LBBB ) Infective Endocarditis Hyperkalemia Cardiac Injury Massive Pulmonary Embolism Ventricular Hypertrophy Myocarditis

11. FASCICLE BLOCK - TYPES Unifascicular Block LAFB LPFB RBBB Bifascicular Block LBBB RBBB + LAFB RBBB + LPFB Definite Trifascicular Block Alternating BBB RBBB + alternating fascicular block RBBB + Mobitz type 2 second Deg AV Block LBBB + Mobitz type 2 second Deg AV Block Possible Trifascicular Block Complete AV Block with ventricular escape rhythm Any Bifascicular Block + 1ST or 2nd deg AV Block

13. rS in L2,3,aVf

14. R in aVL ,L1

15. Absent q in V5 V6

17. rS in aVL , L1, V1 V2

18. R in L2 L3 aVF

19. Rs in V5 V6

20. QRS duration Normal

21. Increased QRS voltage

22. Increased VAT

24. THANK YOU