ECG Guru - Instructor Resources - LPFB https://www.ecgguru.com/ecg/lpfb en Acute Anterior-lateral M.I. With Right Bundle Branch Block and Left Posterior Fascicular Block https://www.ecgguru.com/ecg/acute-anterior-lateral-mi-right-bundle-branch-block-and-left-posterior-fascicular-block <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/acute-anterior-lateral-mi-right-bundle-branch-block-and-left-posterior-fascicular-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AWRB100%20%282%29.jpg" width="1800" height="1282" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG was obtained from a patient who suffered an occlusion of the left main coronary artery. &nbsp;ST elevation is seen in Leads V1 through V6, as well as I and aVL. &nbsp;This is an indicator that the circumflex artery is included in this M.I., and the occlusion is above the bifurcation of the LM and the circ. &nbsp;The patient also has a <strong>right bundle branch block</strong>&nbsp;and a <strong>left posterior fascicular block. &nbsp;</strong>This<strong> bi-fascicular block</strong> can be a dangerous complication of acute M.I., as two of the three main bundle branches are no longer functional.</p><p>The ECG shows typical ST depression, probably reciprocal to the elevation, in the inferior leads.</p><p>The right bundle branch block is diagnosed by the following criteria: &nbsp;1) Wide QRS; &nbsp;2) Supraventricular rhythm; and 3) rSR' pattern in V1 with Rs with a wide little s wave in Leads I and V6.</p><p>The left posterior fascicular block is diagnosed by right axis deviation and by ruling out other causes of right axis deviation. &nbsp;In RAD, Lead III will have a taller positive ( R ) wave than Lead II, and a negative Lead I.</p><p>This type of occlusion is often called the "Widow Maker", and requires very rapid intervention to restore blood flow and prevent complicatons. &nbsp;If there is good news, it is that there are no pathological Q waves, which would indicate necrosis, and this patient was taken quickly to a full-service cardiac center with interventional cath labs and open heart surgery available.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/335/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Acute Anterior-lateral M.I. With Right Bundle Branch Block and Left Posterior Fascicular Block 1/5</option><option value="40">Give Acute Anterior-lateral M.I. With Right Bundle Branch Block and Left Posterior Fascicular Block 2/5</option><option value="60">Give Acute Anterior-lateral M.I. With Right Bundle Branch Block and Left Posterior Fascicular Block 3/5</option><option value="80">Give Acute Anterior-lateral M.I. With Right Bundle Branch Block and Left Posterior Fascicular Block 4/5</option><option value="100" selected="selected">Give Acute Anterior-lateral M.I. With Right Bundle Branch Block and Left Posterior Fascicular Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.4</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-YDz7enjtPUoSf7rPZ_OdEe6l-JsisRSd-zz576A0K0w" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-wall-mi-5" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior wall M.I.</a></div><div class="field-item odd"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item even"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</a></div><div class="field-item odd"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div><div class="field-item even"><a href="/ecg/left-posterior-fascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left posterior fascicular block</a></div><div class="field-item odd"><a href="/ecg/lpfb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LPFB</a></div><div class="field-item even"><a href="/ecg/hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hemiblock</a></div><div class="field-item odd"><a href="/ecg/anterior-lateral-wall-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior-lateral wall M.I.</a></div><div class="field-item even"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item odd"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Facute-anterior-lateral-mi-right-bundle-branch-block-and-left-posterior-fascicular-block&amp;title=Acute%20Anterior-lateral%20M.I.%20With%20Right%20Bundle%20Branch%20Block%20and%20Left%20Posterior%20Fascicular%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Thu, 21 Aug 2014 17:45:01 +0000 Dawn 593 at https://www.ecgguru.com https://www.ecgguru.com/ecg/acute-anterior-lateral-mi-right-bundle-branch-block-and-left-posterior-fascicular-block#comments Right Bundle Branch Block With Left Posterior Fascicular Block https://www.ecgguru.com/ecg/right-bundle-branch-block-left-posterior-fascicular-block <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/right-bundle-branch-block-left-posterior-fascicular-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/RB%20107.jpg" width="1800" height="1087" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This is a good clear example of right bundle branch block with left posterior fascicular block. &nbsp;The RBBB is diagnosed by the following criteria: &nbsp;wide QRS (.12 sec), supraventricular rhythm (NSR), an rsR' pattern in V1, and wide little s waves in I and V6. &nbsp;The LPFB is inferred by the right axis deviation (Lead III QRS is a bit taller than Lead II and Leads I and aVL are negative), and the fact that there is no other obvious cause for right axis shift noted in this patient. &nbsp;This constitutes a BIFASCICULAR BLOCK. &nbsp;The ventricles are being depolarized by way of the anterior fascicle. &nbsp;In addition, there are slight ST elevations in many leads, with an upward coving in the anterior-septal leads (V1, V2, V3). &nbsp;Depending upon the patient's history and presentation, this could represent a recent M.I. or pending issues. The borderline first-degree AV block may be of concern in this patient, since first-degree AVB is associated with progression of bifascicular block to complete heart block. &nbsp;Reference: &nbsp;<a title="Bifasc Block" href="http://www.ncbi.nlm.nih.gov/pubmed/20075529/">Ann Card Anaest, 2010 Jan-Apr;13(1):7-15. doi: 10.4103/0971-9784.58828</a></p><p>&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/335/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Right Bundle Branch Block With Left Posterior Fascicular Block 1/5</option><option value="40">Give Right Bundle Branch Block With Left Posterior Fascicular Block 2/5</option><option value="60">Give Right Bundle Branch Block With Left Posterior Fascicular Block 3/5</option><option value="80" selected="selected">Give Right Bundle Branch Block With Left Posterior Fascicular Block 4/5</option><option value="100">Give Right Bundle Branch Block With Left Posterior Fascicular Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-iNMAOAiKVFn_g24O8mXeKT9OsJxszQDnLxeASYg5nKU" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item odd"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</a></div><div class="field-item even"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div><div class="field-item odd"><a href="/ecg/left-posterior-fascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left posterior fascicular block</a></div><div class="field-item even"><a href="/ecg/hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hemiblock</a></div><div class="field-item odd"><a href="/ecg/lpfb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LPFB</a></div><div class="field-item even"><a href="/ecg/bifascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bifascicular block</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fright-bundle-branch-block-left-posterior-fascicular-block&amp;title=%20Right%20Bundle%20Branch%20Block%20With%20Left%20Posterior%20Fascicular%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 13 May 2013 14:09:47 +0000 Dawn 445 at https://www.ecgguru.com https://www.ecgguru.com/ecg/right-bundle-branch-block-left-posterior-fascicular-block#comments