LBBB in Cerebral Hæmorrhage

Report:

Sinus rhythm

SVEBs

Left bundle branch block

Primary T wave changes

Comment:

The patient was on Warfarin for intermittent AF in COCM (EF 30%); the INR was 3.9 at the time of the bleed. Old patients are at very high risk, perhaps due to cerebral atrophy.

The LBBB has an unusually rightward axis for both LBBB and the patient’s age: +75o. It used to be called “vertical heart”: not exactly abnormal RAD, but aVL and aVF converging. In this case it was probably a reflection of primary congestive cardiomyopathy. There were some primary T wave changes earlier (concordant Ts inferolaterally in the tracing below, Fig 26a), also a reflection of myocardial disease. Now this pattern became much more marked and associated with concordant anterior T wave inversion. The pattern is indistinguishable from that of myocardial infarction.

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