[ECG of the day] ECG 1

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What is your diagnosis? 
  1. Left bundle branch block
  2. left anterior fasicular block
  3. left posterior fasicular block
  4. right bundle branch block


Answer

Answer is Left anterior fasicular block or left anterior hemiblock.

Left anterior hemiblock is caused by interruption of the anterior division of the left bundle branch. This fascicle is fragile, easily exposed to damage, and has a single blood supply (the left anterior descending coronary artery).
Common Causes Left anterior fascicular block can be seen in approximately 4% of cases of acute myocardial infarction.

  • It is the most common type of intraventricular conduction defect seen in acute anterior myocardial infarction, and the left anterior descending artery is usually the culprit vessel. 
  • It can be seen with acute inferior wall myocardial infarction. 
  • It also associated with hypertensive heart disease, aortic valvular disease, cardiomyopathies, and degenerative fibrotic disease of the cardiac skeleton. Causes in Alphabetical Order
Criteria for LAHB

  • Left axis deviation (usually between -45° and -90°), some consider -30° to meet criteria 
  • QRS interval < 0.12 seconds 
  • qR complex in the lateral limb leads (I and aVL) 
  • rS pattern in the inferior leads (II, III, and aVF) 
  • Delayed intrinsicoid deflection in lead aVL (> 0.045 s)


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