Case 129: A 73-Year-Old Woman in Cardiology Clinic
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
A 73-year-old woman suffered from a myocardial infarct 6 years ago, but recovered and is free of angina. Routine ECG recorded in the cardiac clinic is as follow: 
Diagnosis
- Sinus bradycardia, 50/min
- Left anterior fascicular block (LAFB) and Right bundle branch block (RBBB) (RBBB plus LAFB: Bifascicular block)
In RBBB the first 60 msec portion of the QRS reflects left ventricular activation.
The presence of a left fascicular block can therefore be diagnosed.
ECG 2
7 months later a follow-up ECG is recorded:
ECG 2 Diagnosis
Notice the change in the QRS pattern. Right bundle branch block is no longer present. The ECG shows only the pattern of left anterior fascicular block.
ECG ID: E191