LBBB

A left bundle branch block is defined by a wide QRS (> 120 msec), a dominant S wave in V1 and a slurred R wave in V6.

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypertension 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm ST Elevation 31864

This ECG is from a woman in her 50s who presented with chest pressure on a background of heart failure and hypertension. BP 223/125.

This ECG shows sinus rhythm, LBBB and anterior ST elevation. Sgarbossa positive but modified sgarbossa negative. Echo showed LVH, troponin did show a rise and fall, MIBI showed normal perfusion. The most likely cause was a type II MI. The ECG changes did not evolve and were likely baseline changes.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Tachycardia SVT Wide complex tachycardia LBBB Dr Smith's ECG Blog CC BY-NC
Ventricular Tachycardia? Or SVT with Aberrancy? 29404
In the ECGquest archives, this ECG has been tagged with: - Abdominal pain 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ECG of the Week CC-BY-NC-SA
ECG of the Week – 5th November 2018 – Interpretation 27729

This ECG is from a man in his 70s who presented with epigastric pain on a background of hypertension.

This ECG shows LBBB and occasional PVCs with discordant changes that do not meet Sgarbossa criteria. The patient self-discharged against advice before an echo could be completed for possible LVH.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Serial 12-lead Fragmented QRS Tachycardia Wide QRS Wide complex tachycardia LBBB Dr Smith's ECG Blog CC BY-NC
Sudden Chest pain and SOB with a Wide Complex Tachycardia 26151

This ECG is from a man in his 60s who presented with sudden onset severe chest pain and dyspnoea. He had no medical history or medications. On arrival he was in extremis with altered mentation, cyanosis and diaphoresis . There was no palpable radial pulse. Pulse oximetry read HR 170 and saturation 53%. This was the initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Serial 12-lead Fragmented QRS Normal P waves Tachycardia Wide QRS Sinus tachycardia Wide complex tachycardia LBBB Dr Smith's ECG Blog CC BY-NC
Sudden Chest pain and SOB with a Wide Complex Tachycardia: Repeat after unsynchronised cardioversion 26436

This ECG is from a man in his 60s who presented with sudden onset severe chest pain and dyspnoea. He had no medical history or medications. On arrival he was in extremis with altered mentation, cyanosis and diaphoresis . There was no palpable radial pulse. Pulse oximetry read HR 170 and saturation 53%. This was the repeat ECG after unsynchronised cardioversion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Excessive discordant ST elevation LBBB Acute Inferior MI Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
A 60-something year old man with chest pain and a wide QRS 25466

This ECG is from a man in his 60s who presented with chest pain for several hours on a background of prior coronary artery disease and hypertension.

This ECG shows LBBB with excessively discordant ST elevation in inferior leads with reciprocal changes in I and aVL. The cause was a RCA in-stent restenosis.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Excessive discordant ST elevation Normal Axis Reciprocal ST depression LBBB Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Left Bundle Branch Block, Severe Chest pain, Previous Normal Angio. What is going on? Repeat ECG 24 min later. 29116

This ECG is from a middle aged woman who presented with sudden severe substernal chest pain on a background of idiopathic cardiomyopathy and biventricular failure.

This ECG shows LBBB (not paced rhythm) with excessive discordant ST elevation in III and aVF with reciprocal change in aVL. The cause was an acute lateral MI, likely due to embolism from a left atrial appendage thrombus.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Electrode misplacement Normal Axis LBBB Dr Smith's ECG Blog CC BY-NC
Left Bundle Branch Block, Severe Chest pain, Previous Normal Angio. What is going on? 24495

This ECG is from a middle aged woman who presented with sudden severe substernal chest pain on a background of idiopathic cardiomyopathy and biventricular failure.

This ECG shows LBBB (not paced rhythm) with probable swapped limb electrodes but no ECG evidence of ischemia. The patient was monitored and later developed diagnostic changes of an acute lateral MI, likely due to embolism from a left atrial appendage thrombus.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Standard Calibration Concordant ST elevation Normal Sinus Rhythm LBBB Acute Inferior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Is there Wellens’ syndrome in left bundle branch block? Or in inferior and lateral leads? 17979

This ECG is from a man in his 80s who presented with acute chest pain.

This ECG shows LBBB with concordant STE in II, V5 and V6 due to inferior and lateral MI.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Coved ST elevation ST elevation in aVL Normal Sinus Rhythm LBBB ECG Interpretation CC-BY-NC-SA
ECG Blog #146 – (BBB – Primary ST-T Changes) 17366

This ECG is from a patient of unknown age who presented with acute chest pain.

This ECG shows LBBB with concordant ST changes in III, aVF and aVL most likely due to acute MI. The patient was not sent to the cath lab. They arrested and could not be resuscitated.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Normal Axis Normal P waves Short PR Wide QRS Wide complex tachycardia LBBB ECG of the Week CC-BY-NC-SA
ECG of the Week – 1st January 2018 – Interpretation 2 16765

This ECG is from a woman in her 20s with a known history of pre-excitation and prior ablation.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Fatigue 12-Lead Concordant ST depression in V1-V3 Concordant ST elevation Normal Axis LBBB Second degree AV block type 1 - Wenckebach Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
See what happens when one fails to diagnose STEMI in LBBB and Paced Rhythm 14448

This ECG is from a female in her 60s presented with 2-3 days of fatigue and shortness of breath. She called EMS when her symptoms acutely worsened while she was shopping. EMS arrived and recorded a heart rate of 27. On arrival to the ED she was noted to be in complete heart block. She was given atropine with transient increase in HR to 80s. This ECG was recorded after atropine.

This ECG shows sinus rhythm with second degree type 1 AV block and LBBB. Concordant ST elevation in III and aVF and concordant ST depression in V2. The cause was an occluded proximal right coronary artery. This was missed and the patient died.

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