EKG Conduction abnormalities Part I Sandra Rodriguez, M.D. RBBB
QRS > 120msec. Terminal forces oriented rightward and anteriorly. rSR complex in V1. Terminal S waves in I, AVL, V6.
Terminal R wave in aVR. Normal axis. ST-T should be negative in leads with terminal R forces (secondary). RBBB with ST-T abnormalities
LBBB QRS >120msecs. Terminal forces oriented leftward and posteriorly.
Terminal S wave in V1. Terminal R wave in I, aVL, V6. LBBB Left Fascicular Anterior Block
QRS axis -45 to -90 degrees. QRS duration <120msecs unless RBBB. rS complexes in II, III, aVF. Small q wave in I, aVL. Poor R progression in leads V1-V3 and
deeper S waves in leads V5 and V6. R-peak time in lead aVL >0.04s, often with slurred R wave downstroke Differential Some cases of inferior MI with Qr complex in
lead II (making lead II 'negative')
Inferior MI + LAFB in same patient (QS or qrS complex in lead II) Some cases of LVH Some cases of LBBB Ostium primum ASD and other endocardial cushion defects. Some cases of WPW syndrome (large negative delta wave in lead II)
LAFB Left Posterior Fascicular Block Right axis deviation in the frontal plane
(usually > +100 degrees) rS complex in lead I qR complexes in leads II, III, aVF, with R in lead III > R in lead II QRS duration usually <0.12s unless coexisting RBBB
Very Rare defect. Differential Many causes of right heart overload and pulmonary hypertension
High lateral wall MI with Qr or QS complex in leads I and aVL Some cases of RBBB Some cases of WPW syndrome Children, teenagers, and some young adults
Bifascicular Blocks RBBB plus either LAFB (common) or LPFB (uncommon) Features of RBBB plus frontal plane
features of the fascicular block (axis deviation, etc.) RBBB plus LAFB Method
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