This ECG is taken from an 82-year-old man who called 911 because of chest pain. He has an unspecified “cardiac” history, but we do not know the specifics.
Left anterior hemiblock
This series of three ECGs is from a 60-year-old man who was brought to the Emergency Department after being involved in a motor vehicle accident. No injuries were found, but the patient was severely intoxicated by alcohol consumption. He was conscious but agitated.
ECG NO. 1 15:07:23
We have no clinical information about this patient, except that he was complaining of chest pain, and was initially treated by prehospital paramedics.
This ECG provides an example of LEFT ANTERIOR FASCICULAR BLOCK (LAFB). It is from a 71-year-old woman for whom we have no other history. She also has first-degree AV block and right bundle branch block. RBBB and LAFB together are called bifascicular block. It is not uncommon to see this type of bifascicular block, as the right bundle branch and the anterior fascicle of the left bundle share a blood supply.
This ECG provides an example of LEFT ANTERIOR FASCICULAR BLOCK (LAFB). It is from an elderly woman for whom we have no other history.
This is a nice, clear right bundle branch block pattern: wide QRS, supraventricular rhythm (NSR), and rSR' pattern in V1. Wide little s waves in Leads I and V6 are also diagnostic. The left axis deviation indicates a left anterior fascicular block, since there is no other apparent reason for the left axis deviation, such as pathological Q waves or LVH. Left anterior fascicular block is a diagnosis of exclusion, also considering that RBBB and LAFB are often seen together (bifascicular block), since the two fascicles have the same blood supply.
This is a "Routine" resting 12-lead ECG I performed on a patient several months ago in the Outpatient ECG Lab.
PATIENT CLINICAL DATA:
72-year-old white man; asymptomatic; resting comfortably in recumbent position.
This is an exercise in "anomalous" beats.
(1.) Specifically, what are 3rd, 4th, and 10th beats?
A good example of aberrantly conducted premature beats (PACs or possibly PJCs) that are conducted with a left anterior fascicular block. The underlying rhythm is sinus at about 80/min. The timing of the premature beats is best seen in the Lead II rhythm strip at the bottom, as this ECG machine does not print the 12 leads in an uninterrupted manner. You will see interruptions each time the leads change.
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.
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