Morning Report: 1/16/2014

Thanks to Dr. Freedman for today’s Morning Report!

Fascicular Block (Hemiblock)

Definition:  Conduction delay in of the main divisions of the left bundle, either anterior or posterior

LAFB Criteria:

• Dominant R waves in I, aVL
• Dominant S waves in II, III, aVF
• No evidence for any other cause of LAD
• “LAD without a cause”

DDx of LAD:

• LBBB
• LVH?
• Inferior MI
• Ventricular Ectopy
• Paced rhythm
• WPW
• LAFB^{*#$%^}

LPFB Diagnostic Criteria

• Dominant R waves in II, III, aVF
• Dominant S waves in I, aVL
• No evidence for any other cause of RAD
• “RAD without a cause”

DDx of RAD

• Lateral MI
• RVH (criteria?)
• Lung disease, acute or chronic
• Hyperkalemia
• Sodium channel blocker toxicity
• Ventricular Ectopy
• Normal finding in pediatrics
• WPW
• LPFB^{*#$%^}

Bifascicular Block

-RBBB + LAFB/LPFB

Trifascicular Block

 -1^st Degree AV Block + Bifascicular block

Clinical significance

-Conduction system disease

• Electrolyte disturbance
• Ischemia/infarction
• Congenital
• structural

So?

Maybe something, maybe nothing.

Get old and serial ECGs

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• Bio
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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

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