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EKG Conduction abnormalities Part I

EKG Conduction abnormalities Part I. Sandra Rodriguez, M.D. RBBB. QRS > 120msec. Terminal forces oriented rightward and anteriorly. rSR’ complex in V1. Terminal S waves in I, AVL, V6. Terminal R wave in aVR. Normal axis. ST-T should be negative in leads with terminal R forces (secondary).

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EKG Conduction abnormalities Part I

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  1. EKGConduction abnormalitiesPart I Sandra Rodriguez, M.D.

  2. RBBB • QRS > 120msec. • Terminal forces oriented rightward and anteriorly. • rSR’ complex in V1. • Terminal S waves in I, AVL, V6. • Terminal R wave in aVR. • Normal axis. • ST-T should be negative in leads with terminal R forces (secondary).

  3. RBBB with ST-T abnormalities

  4. LBBB • QRS >120msecs. • Terminal forces oriented leftward and posteriorly. • Terminal S wave in V1. • Terminal R wave in I, aVL, V6.

  5. LBBB

  6. Left Fascicular Anterior Block • QRS axis -45 to -90 degrees. • QRS duration <120msecs unless RBBB. • rS complexes in II, III, aVF. • Small q wave in I, aVL. • Poor R progression in leads V1-V3 and deeper S waves in leads V5 and V6. • R-peak time in lead aVL >0.04s, often with slurred R wave downstroke

  7. Differential • Some cases of inferior MI with Qr complex in lead II (making lead II 'negative') • Inferior MI + LAFB in same patient (QS or qrS complex in lead II) • Some cases of LVH • Some cases of LBBB Ostium primum ASD and other endocardial cushion defects. • Some cases of WPW syndrome (large negative delta wave in lead II)

  8. LAFB

  9. Left Posterior Fascicular Block • Right axis deviation in the frontal plane (usually > +100 degrees) • rS complex in lead I • qR complexes in leads II, III, aVF, with R in lead III > R in lead II   • QRS duration usually <0.12s unless coexisting RBBB • Very Rare defect.

  10. Differential • Many causes of right heart overload and pulmonary hypertension • High lateral wall MI with Qr or QS complex in leads I and aVL • Some cases of RBBB • Some cases of WPW syndrome • Children, teenagers, and some young adults

  11. Bifascicular Blocks • RBBB plus either LAFB (common) or LPFB (uncommon) • Features of RBBB plus frontal plane features of the fascicular block (axis deviation, etc.)

  12. RBBB plus LAFB

  13. Method • Measurements • Rhythm Analysis • Conduction Analysis • Waveform Description • ECG Interpretation • Comparison with Previous ECG (if any)

  14. Case 1

  15. Case 2

  16. Case 3

  17. Case 4

  18. Case 5

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