281mustang
Forum Lieutenant
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I have five. Here they are:
1.
2.
3.
4.
5.
Gracious.
1.
2.
3.
4.
5.
Gracious.
Lets play "guess that EKG"
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Aidey
Community Leader Emeritus
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I'm on my phone, which makes it really hard to see details. But 1 is a lateral MI, 3 is a LBBB and 5 is A Flutter, looks like it is varying between 2:1 and 3:1.
Hunter
Forum Asst. Chief
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I have five. Here they are:
1.
Slight St elevation in II avf v4 v5 v6?
Slight depression in II and afv?2.
3.
LBBB?
4.
Having trouble with this one, maybe a borderline 1st degree block? kinda hard to tell on my phone.
Looks like AFlutter5.
Gracious.
And RBBB, and possibly left posterior hemiblock. In which case you will have a bi-fascicular block
And 1st degree heart block = tri-fascicular block
Not always...
http://www.ekginterpretation.com/library/trifascicular-block/
http://www.uptodate.com/contents/course-and-treatment-of-chronic-bifascicular-block
I get what you are saying though. It's 3 blocks, but not necessarily 3 blocked fascicles.
http://www.ekginterpretation.com/library/trifascicular-block/
http://www.uptodate.com/contents/course-and-treatment-of-chronic-bifascicular-block
I get what you are saying though. It's 3 blocks, but not necessarily 3 blocked fascicles.
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Hunter
Forum Asst. Chief
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Pardon my ignorance what's a tri-fascicular block?
I take a bow before superior knowledge. Will take a look at links when I'm more awake and compare with my books. Back later
That statement is incorrect. First degree heart block has nothing to do with fascicular blocks.
A "fascicular block" refers to a block in either the RBBB, LAFB, or LPFB. A bifascicular block refers to a block of the RBBB and one of the left-sided fascicles. As someone else has pointed out, a tri-fascicular block would be a total heart block.
A bifascicular block indicates the conduction system is already damaged significantly. It's like firing on only one cylinder out of three - not a good thing if that third cylinder goes out.
It might be a good idea to remove the name of the hospital and the tech's initials before posting examples. Even without the name of the patient, some places may not want to give the impression parts of their medical records are available to be posted on a public forum unless it is identified as teaching only and then they may reserve the right to their materials and usage.
Christopher
Forum Deputy Chief
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1. Early Repol versus Pericarditis. Fishhooked J-points, PR-depression in II/PR-elevation in aVR, diffuse ST-E.
2. Maybe a PE (S1Q3T3), maybe ACS. I'd trend this patient's ECG's and get a posterior view.
3. I pretty much agree with the monitor. 1AVB and LBBB. Would trend to see if the ST-E changes in the right precordials, otherwise I'm unimpressed.
4. RBBB, inferior axis, 1AVB; maybe "bifasicular block". If this patient was in for a syncopal episode I'd pay attention to their rhythm pretty closely. V2/V3 have odd lead placement I'll bet.
5. Again, I feel pretty comfortable with the monitor on this one. Atrial flutter with a variable block.
2. Maybe a PE (S1Q3T3), maybe ACS. I'd trend this patient's ECG's and get a posterior view.
3. I pretty much agree with the monitor. 1AVB and LBBB. Would trend to see if the ST-E changes in the right precordials, otherwise I'm unimpressed.
4. RBBB, inferior axis, 1AVB; maybe "bifasicular block". If this patient was in for a syncopal episode I'd pay attention to their rhythm pretty closely. V2/V3 have odd lead placement I'll bet.
5. Again, I feel pretty comfortable with the monitor on this one. Atrial flutter with a variable block.
ZootownMedic
Forum Lieutenant
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1.) 1st Degree AVB (prolongnation of PR interval > 0.2 secs)
2.) RBBB
3.) Either a Left Posterior or Left Anterior fasicular block.
-ALL AT THE SAME TIME
Hunter
Forum Asst. Chief
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1.) 1st Degree AVB (prolongnation of PR interval > 0.2 secs)
2.) RBBB
3.) Either a Left Posterior or Left Anterior fasicular block.
-ALL AT THE SAME TIME
So... someones AFU...
TatuICU
Forum Lieutenant
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1.) 1st Degree AVB (prolongnation of PR interval > 0.2 secs)
2.) RBBB
3.) Either a Left Posterior or Left Anterior fasicular block.
-ALL AT THE SAME TIME
No. Once again a misuse of the nomenclature.
Brandon O
Puzzled by facies
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Trifascicular block is a slang term which is not useless but, as we're seeing, is not universal enough to use without knowing your audience.
I believe Bob Page may have popularized it among EMS?
I believe Bob Page may have popularized it among EMS?
That is exactly on point! I made a quick picture illustration to show the differences in various blocks.
http://tinypic.com/r/280nm9v/6
hemi-
A prefix meaning "half," as in hemisphere, half a sphere.
In cardiology this means:
Hemi means half and block means a block. Thus when you have a hemiblock you have a half that is blocked.
Hemifascicles are the anterior located at the front and the posterior
located at the back. These fascicles make up the left bundle branch conduction pathway. (See diagram)
In the heart you can have various blocks (or a combination of thereof)
SA blocks Sino-Atrial blocks: (blocks at SA node)
Sinus pause
Sinus arrest
Sinus block
All associated with Adam stokes syndrome.
AV blocks Atrio-Ventricular blocks (blocks at the AV junction)
1 degree HB
2 nd degree type 1 and 2
3 rd degree complete HB (Heart Block)
Intra-Ventricular blocks (Means blocks inside the ventricles)
RBBB Right Bundle Branch Block
LBBB Left Bundle Branch Block (here both fascicles are blocked)
Hemiblocks: Anterior hemifasicle block and Posterior hemifascicle block
If you have 2 blocks out of these 3 categories pick and choose any
then it's a severe degree of block. The term bifascicular however only refers to Intra-Ventricular Conduction system if you want to be specific and the quote above details the combinations. However all these EKG changes need to be taken into account with patient presentation, vital signs, chief complaint etc... A 12/15 Lead EKG NEVER RULE OUT AN AMI!
Disregard any spelling typos.
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Christopher
Forum Deputy Chief
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Grrr: "if you say 'block' more than 17 times, lead II has no dice." Or something catchy like that!
But to stir the pot you could have a 1AVB due to problems below the AVN. Say RBBB with some slowing in the left bundle branches side of the His.