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Multi-lead assessment

Left Bundle Branch Block

Thu, 08/07/2014 - 21:57 -- Dawn

This is a good example of sinus rhythm with left bundle branch block.  There is some irregularity due to a PAC at the beginning.  The QRS is wide at 144 ms (.14 seconds).  There is also first-degree AV block, with a prolonged PR interval of 228 ms.  The criteria for diagnosis of left BBB are:  wide QRS, supraventricular rhythm, and a negatively-deflected QRS in V1 with a positive QRS in Leads I and V6.  

Teaching Tip: 12 Leads are Better Than One (Or Three)

Tue, 11/05/2013 - 15:41 -- Dawn

Years ago, I was tasked with introducing 12-lead ECG interpretation to firefighter/paramedics who had been using ECG for rhythm monitoring for years.  Some were eager to add to their skills, others - not so much.  The feeling was, we have been doing just fine as we are.  When finally convinced that they could interpret STEMI with a 12-lead, many were content to use the 12-lead ECG only for that.  

Left Bundle Branch Block

Tue, 10/15/2013 - 01:02 -- Dawn

This ECG offers a good example of the left bundle branch block pattern.   * The QRS is wide at 144 ms.  * There is a supraventricular rhythm - in this case, normal sinus rhythm with beat number two a PAC, and a slightly prolonged PR interval.  * The QRS is negative in V1 and positive in V6 and also Lead I.  This satisfies the ECG criteria for left bundle branch block.

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