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The axis
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Left anterior fascicular block can occur as a result of fibrosis of the conducting system (of any cause) or from myocardial infarction. On its own, it is not thought to carry any prognostic significance. However, left anterior fascicular block in combination with right bundle branch block means that two of the three main conducting pathways to the ventricles are blocked. This is termed bifascicular block (Figure 10.17).
Trypanosoma cruzi
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Paula Andrea Jiménez, Jesus Eduardo Jaimes, Juan David Ramírez
The most frequent electrocardiographic findings are right bundle branch block, left anterior fascicular block, premature ventricular beats, ST-T segment changes, abnormal Q waves, and voltage drop in the QRS complex. It is common for patients with this disease to have both right bundle branch block and left anterior fascicular block. In addition, it is necessary to mention that one of the characteristic findings of this condition are the ventricular compromise including ventricular dysfunction and tachycardia in monitoring with a Holter device [46,47].
The axis
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
Left anterior fascicular block can occur as a result of fibrosis of the conducting system (of any cause) or from myocardial infarction. On its own, it is not thought to carry any prognostic significance. However, left anterior fascicular block in combination with right bundle branch block (p. 153) means that two of the three main conducting pathways to the ventricles are blocked. This is termed bifascicular block (Fig. 10.17).
Abstracts from the Seventh Annual Baylor University Medical Center Medical Education Research Forum 2021
Published in Baylor University Medical Center Proceedings, 2021
Kashif Waqiee Ahmed, Thomas Cox, Jennifer Olvera, Natalie Gittus, Kirsten Ryan, Cristie Columbus
Monomorphic ventricular tachycardia (VT) has a broad differential. We present a case illustrating the importance of utilizing various imaging modalities for noninvasively eliciting the etiology of VT. A 55-year-old African American man presented to the emergency department for a postcoital monomorphic VT arrest requiring cardioversion. An electrocardiogram showed first-degree atrioventricular block, left anterior fascicular block, and right bundle branch block. A transthoracic echocardiogram showed a left ventricular ejection fraction of 50% with hypokinesis of the basal to mid anterior and anterolateral walls along with excessive right ventricular trabeculations. Cardiac catheterization showed normal coronaries. Cardiac magnetic resonance imaging revealed a diffuse epimyocardial scar along the basal and mid anterior, inferolateral, and anterolateral walls and a subendocardial scar along the basal and mid septum. The scar pattern suggested infiltrative disorders, inflammation, or rare dysplasia with fibrosis. No scar was seen in the right ventricle. Positron emission tomography revealed few small areas of mild fluorodeoxyglucose activity in the basilar to mid anterior wall, distal anterior wall near the apex, and basilar inferoseptal region. There was also evidence of old granulomatous disease in the liver. Given the classic electrocardiographic findings, clinical picture, and imaging findings, cardiac sarcoidosis was confirmed and steroids were initiated. Cardiac sarcoidosis as a cause of monomorphic VT remains an evasive diagnosis; a multimodality imaging strategy can help confirm the diagnosis.
Mechanical dispersion is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks
Published in Annals of Medicine, 2018
Ivan Stankovic, Aleksandra Janicijevic, Aleksandra Dimic, Milica Stefanovic, Radosav Vidakovic, Biljana Putnikovic, Aleksandar N. Neskovic
Our data are in line with previous studies demonstrating that LV contraction patterns are related to different myocardial electrical activation patterns [20,27,28]. In a study by Risum et al. [27], there was a close association between LBBB defined by strict criteria proposed by Strauss et al. [29] and LBBB contraction pattern by speckle-tracking strain. In addition, Leeters et al. [28] reported that wall motion abnormalities between inferior and anterior LV walls in patients with RBBB and left anterior fascicular block are similar to abnormalities found between septal and lateral LV walls in patients with LBBB. However, it should be noted that prognostic implications of QRS morphology can also be gender-specific, as shown by Zusterzeel et al. [30]. Among patients with LBBB, women had a 21% lower mortality risk than men while there were no sex differences in non-LBBB group [30]. In this study, there was a higher prevalence of mechanical dyssynchrony among women, and it might have translated into more favourable survival, if patients had been treated by CRT. However, since patients in this study did not receive CRT, it was not surprising that the gender was not associated with outcome.
The sensitivity of DPD scintigraphy to detect transthyretin cardiac amyloidosis in V30M mutation depends on the phenotypic expression of the disease
Published in Amyloid, 2020
Maria C. Azevedo Coutinho, Nuno Cortez-Dias, Guilhermina Cantinho, Susana Gonçalves, Miguel Nobre Menezes, Tatiana Guimarães, Gustavo Lima da Silva, Ana Rita Francisco, João Agostinho, Laura Santos, Isabel Conceição, Fausto J. Pinto
None of the patients suffered from overt heart failure. However, subclinical cardiovascular abnormalities were very common and 79 patients (44.1%) had been previously submitted to pacemaker implantation. ECG abnormalities were present in 96 patients (53.6%), the most frequent were left anterior fascicular block (N = 29; 17.9%), first degree AV block (N = 28; 15.6%) and poor R wave progression in precordial leads (N = 25; 14%). Holter abnormalities were detected in 81 patients (45.3%), most frequently AV conduction defects and/or pacing rhythm. ABPM revealed high BP in 43 patients (24%) and abnormal circadian BP pattern in 78 individuals (44%). Late H/M MIBG uptake was <1.60 in 58 patients (34.7%). The median value of NT-proBNP was 100 (48 − 215) pg/ml.