ECG: Bifascicular Block

1. ECG OF THE WEEK PROF.S.SUNDAR UNIT

2. ECG FINDING RATE 150/MIN RHYTHM AF/IRREGULARLY IRREGULAR AXIS -80⁰/LEFT AXIS DEVIATION P WAVE ABSENT QRS COMPLEX Q WAVE V1-V4 SECONDARY R WAVE WITH SLURRING,WIDENING V1-V4 WIDENED TERMINAL S WAVE V5,6 S/O AWMI WITH RBBB rS pattern in II,III and aVF s/o LAFB A SINGLE VENTRICULAR ECTOPIC IS SEEN ST SEGMENT Elevation v1-v4 s/o ACUTE AWMI T WAVE SYMMETRICAL, DEEP INVERSION V1 -V4 S/O PRIMARY CHANGES

3. DIAGNOSIS ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION WITH BI-FASCICULAR BLOCK(RBBB WITH LAFB) ATRIAL FIBRILLATION

4. MI WITH BLOCK LBBB MAY BE MISINTERPRETED AS RECENT ANTROSEPTAL MI MI MAY BE MASKED BY PRESENCE OF LBBB RBBB NEITHER MIMICS NOT MASKS MOST MI

5. MI WITH RBBB RBBB AFFECTS MID AND TERMINAL PORTIONAL OF QRS COMPLEX SINGLE EXCEPTION- POSTERIOR BASAL MI WHICH AFFECT TERMINALPART QRS AND MASKED BY RBBB

6. RBBB WITH ANTERIORWALL MI R WAVE DISAPPEAR IN V1-V4 AND REPLACED BY QWAVE DUE TO INVOLMENT OF ANTERIORWALL OF RV SECONDARY R WAVE PERSIST DUE TO DELAYED ACTIVATION OF UNINVOLVED FREEWALL OF RV

7. RBBB WITH INFERIORWALL MI MINIMAL INFLUENCE ON THE ANTERIORWALL LEADS QWAVE AND ST SEGMENT CHANGES IN INFERIORWALL LEADS ALONG WITH RBBB PATTERN IN PRECARDIAL LEADS

8. PROGNOSIS MI WITH LAFB – MINIMAL ADVERSE EFFECT ON PROGNOSIS MI WITH LAFB WITH RBBB – POOR PROGNOSIS MORTALITY 4-5TIMES INCREASED MI WITH LPFB WITH RBBB – POOR PROGNOSIS MORTALITY 6-7 TIMES INCREASED 10 MI WILL DEVELOP BIFSCICULAR BLOCK

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