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It's the ECG's that george rejects that makes George's ECG's the best.
LBBB: Old Myocardial Infarction
Report:Sinus rhythm 64/min Third degree AV block Junctional escape rhythm 36/min Left bundle branch block QRS 0.22” Probable old anterior infarction Comment:The patient had LBBB since his original infarction; the present morphology is identical to
Incongruous BBBB
Report: Sinus rhythm 84 – 88/min Advanced second degree AV block 3:1 & 4:1 AV block Right bundle branch block PR interval 0.32” Left bundle branch block PR interval 0.20” Comment: This is quite rare. The two bundle branch blocks have different but
LBBB: Negative Concordant Precordial Pattern
Report: Sinus rhythm PR interval 0.20” Left atrial abnormality Normal axis Left bundle branch block Comment: History of infarction and marked cardiomegaly are clues as to why there is a concordant precordial QS pattern. This example has normal axis:
LBBB in Hyperkalæmia
Report: Accelerated junctional rhythm 90 - 96/min ? Sinus rhythm with sino-ventricular conduction Left bundle branch block QRS 0.22” Peaked T waves suggestive of hyperkalæmia Comment: The potassium rose to 8.0 mEq/L and probably higher. The rhythm i
Left Axis Deviation in LBBB Conduction
Report:Sinus rhythm 72/min Borderline left atrial abnormality (LAA) Left bundle branch block Comment:In LBBB conduction the axis is derived from the entire QRS complex (unlike the situation with normal or RBBB conduction, where only the initial 0.06” a
LBBB with Prominent R Wave in V2
Report:Sinus rhythm First degree AV block PR interval 0.24” Left bundle branch block Comment:Prominent narrow R wave in V2, with subsequent diminution (through V5 in this example) is said to be a sign of old anterior infarction with LBBB. In my experi
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 a
Incomplete LBBB
Report:Sinus rhythm 94/min Incomplete LBBB Comment:The QRS is just over 0.10” long and, despite large voltages, there are no “septal” q waves in 1, aVL and V6. The last of these also shows delayed intrinsicoid deflection, but nobody looks at that any mo
Alternating LBBB
Report:Sinus rhythm 87/min Alternating (2:1) left bundle branch block Small frontal plane voltage Nonspecific T wave changes Comment:The patient was admitted to CCU because of chest pain; a new LBBB developed. However, when disseminated carcinoma beca
LBBB with Northwest Axis
Report:Atrial fibrillation with ventricular response 98/min Left bundle branch block Axis approx. +240o Comment:The S wave in lead 1 makes the axis extreme right or left (no man’s land); this seems to have the same significance as right axis deviation