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
-1st 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
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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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
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