Objectives 1. QRS analysis of Right and Left BBB ...

[Pages:31]Bundle Branch & Fascicular Blocks

Reading Assignment (p53-58 in `Outline')

Objectives 1. QRS analysis of Right and Left BBB 2. Uncomplicated vs `complicated' BBB 3. Diagnosis of RBBB with LAFB and LPFB

4. Rate related BBB's 5. Who needs a pacemaker ?

Welcome to the "5-Step Method"

ECG #:

Mearurements: A= V= PR= QRS= QT= Axis=

Rhythm (s):

Conduction:

Waveform:

Interpretation:

1. Compute the 5 basic measurements: HR, PR interval, QRS duration, QT interval, Axis 2. What's the basic rhythm and other rhythm statements (e.g., PACs and PVC's) 3. Any conduction abnormalities (SA blocks, AV blocks (Types I or II), and IV blocks 4. Waveform abnormalities beginning with P waves, QRS complexes, ST-T, and U waves 5. Final interpretations: Normal ECG or Borderline or Abnormal ECG (list final

conclusions)

V1

LBBB

Posterior

V6 I aVL

Left

Monophasic `R'

V1

Anterior

V6

I

aVL

RBBB

Triphasic QRS

Right

I

II III

69 year old man; routine clinic visit 2-1

I

II

III

2-1

Mearurements: A= 80 V=80 PR=160 QRS=140 QT=320 Axis=0

Rhythm (s):

Sinus rhythm; one PVC (from the LV......why the LV?)

Conduction:

? Normal SA, AV ? IVCD

Waveform:

Interpretation:

? late wide S in I, aVL, V5,6 (i.e., at end of the QRS ventricular activation is moving into the RV)

? rsR` in lead V1 (prominent anterior forces; late activation of the RV)

Abnormal ECG: 1. RBBB 2. Rhythm (PVC with late, wide S wave

in V6 indicating LV origin and late rightword activation towards the RV)

62 year old man; ER visit for vague chest discomfort 2-2

2-2

Mearurements: A=70 V=70 PR=160 QRS=130 QT=400 Axis= +120

Rhythm (s): Sinus rhythm

Conduction:

1. Normal SA, AV 2. IVCD

Waveform:

Interpretation:

? Late S in I, aVL, V5-6 ? rsR` in V1 with prominent

anterior forces (PAF) due to RBBB. ? T wave inversion V2-6 (primary T wave abnormality)

Abnormal ECG: 1. RBBB + LPFB (bifascicular block) 2. Primary T wave abnormality (consider

differential diagnoses ? including ischemia and and myocardial infarction and other heart diseases, drugs, CNS insults, etc.)

I

II

III

41 year old man; ER visit for vague chest discomfort 2-3

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