This ECG was obtained from an 84-year-old woman who was scheduled for surgery. When the anesthesiologist did this ECG, the surgery was cancelled. It is a very good example of fascicular-level blocks.
Unfortunately, I have no available clinical data on this patient. Merely looking for an interpretation of the ECG in it's raw form.
This is a good clear example of right bundle branch block with left posterior fascicular block. The RBBB is diagnosed by the following criteria: wide QRS (.12 sec), supraventricular rhythm (NSR), an rsR' pattern in V1, and wide little s waves in I and V6. 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. This constitutes a BIFASCICULAR BLOCK.
This is a good example of acute anterior wall M.I., with ST elevation in V1 through V6, as well as in Leads I and aVL. The extensive distribution of ST segment elevations across the anterior and high lateral walls indicates a proximal LAD artery occlusion. In addition, this ECG shows right bundle branch block, with a QRS width of 144 ms (.14 sec.) and an rsR' pattern in V1.
From June 10, 2012: As is the case with all practical blogs, I’m encouraging ECG Guru members to engage in active group participation. Share your thoughts, observations, impressions, findings, and interpretations. Feel free to compare notes with one another and pick each other’s brains.
Lots of information in this ECG! The underlying rhythm is atrial fibrillation with a controlled rate. The QRS is .12 seconds in duration, with an rSR' pattern in V1 and a wide s wave in Leads I and V6, indicating right bundle branch block. In addition, the axis is leftward - Leads I and aVL are upright and Leads II, III, and aVF are negative. There is no other obvious reason for the left axis shift, and therefore, the diagnosis by exclusion is left anterior fascicular block.
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