Case 72: A 73-Year-Old Woman in the Cardiac Clinic
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
A 73-year-old woman with history of hypertension and mild stable angina is seen for a routine assessment:
Diagnosis
- Sinus bradycardia, 50/min
- Left anterior fascicular block (LAFB)
- Right bundle branch block (RBBB)
- RBBB plus LAFB (Bifascicular block)
ECG 2
The patient is reassessed 7 months later. Her symptom and clinical findings are unchanged. She remains moderately active:
ECG 2 Diagnosis
- Sinus rhythm
- Left anterior fascicular block
- (compared with the previous tracing, right bundle branch block is no longer present)
Please, compare ECG 1 and ECG 2. In patients with right bundle branch block the ventricular depolarization starts in the left ventricle. The first 60 msec. of the QRS therefore are mainly the result of left ventricular depolarization. In the two ECGs the pattern of left anterior fascicular block can be seen. (left axis deviation – qR in I and aVL, rS in the inferior leads)
ECG ID: E349