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ECG: Trifascicular Block
- Added: May, 12th 2011
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- ECG OF THE WEEK
Prof.Dr . G.ELANGOVAN’S unit
Dr.M.Amudhan - 73 year old male presented with c/o giddiness on & off
for past 1yr.
chest pain past 2 days
Past history; not a k/c/o T2DM/SHT/IHD No other significant history
O/E pt concious ,oriented, afebrile.
no pallor/icterus/cyanosis/clubbing/LN/pedal edema
Vitals; PR 84/min BP 150/90
Cvs: s1 s2 heard. No murmurs.
RS: nvbs heard, no added sounds,
Other systems also normal. - In this ECG
Rate – 80/min
Rhythm – sinus rhythm
P wave morphology – normal
PR interval – 0.24 s
QRS duration – 0.16 s, QRS axis: - 40 degrees
QRS morph. – RR’(M pattern) in V5,V6,aVL & L1 with secondary ST-T Changes Deep S waves in V1-V3 & L2 & L3
ST eievation in V1 – V3 - ECG
LBBB + First degree AV block
POSSIBLE TRIFASCICULAR BLOCK
WHICH HAS TO BE
CONFIRMED ONLY BY
HIS BUNDLE ELECTROGRAM - INTRA – VENTRICULAR CONDUCTION DEFECTS
- Abnormality in conduction thru one or more divisions of intra ventricular conduction system distal to Bundle of His
- Various conduction defects include:-
LBBB
LAFB
LPFB
Parietal Block
Peri Infarction Block - Causes Of IVCD :-
Congenital ( RBBB in normal individuals )
IHD ( AMI / PMI / Coronary atherosclerosis )
Cardiomyopathy ( DCM / HCM )
Infiltrative Lesions ( Tumors / Chagas / Hypothyroidism / Amyloidosis )
Aortic stenosis ( LBBB )
Infective Endocarditis
Hyperkalemia
Cardiac Injury
Massive Pulmonary Embolism
Ventricular Hypertrophy
Myocarditis - FASCICLE BLOCK - TYPES
Unifascicular Block
LAFB
LPFB
RBBB
Bifascicular Block
LBBB
RBBB + LAFB
RBBB + LPFB
Definite Trifascicular Block
Alternating BBB
RBBB + alternating fascicular block
RBBB + Mobitz type 2 second Deg AV Block
LBBB + Mobitz type 2 second Deg AV Block
Possible Trifascicular Block
Complete AV Block with ventricular escape rhythm
Any Bifascicular Block + 1ST or 2nd deg AV Block - FASCICULAR BLOCKS
LAFB- LAD (-30 to -80 )
- rS in L2,3,aVf
- R in aVL ,L1
- Absent q in V5 V6
- RS in V5 V6
- RAD ( +120 to + 180 )
- rS in aVL , L1, V1 V2
- R in L2 L3 aVF
- Rs in V5 V6
- QRS duration Normal
- Increased QRS voltage
- Increased VAT
- Sec ST / T wave changes
- LBBB
- 1st degree:- q in V5 V6 disappears
- 2nd degree:- initial slurring of R wave in V5 V6
VAT 0.06 – 0.09 sec
Sec ST / T wave changes- 3rd degree :- wide slurred R wave in V5 V6
QRS >0.12 sec
VAT > 0.09 sec
Sec ST / T wave changes - THANK YOU
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