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Left Posterior Fascicular Block

12/5/2016

1 Comment

 
The posterior fascicle is much large and less susceptible to injury.  As such it is not likely to occur in isolation, and more commonly seen with some AV node dysfunction as a Bifascicular block (LPFB + RBBB).  Dr, Burns walks us through some of expected ECG findings and also reminds that you should not dx LPFB without first considering more worrisome causes of right axis deviation: PE, TCA overdose, lateral MI, or RVH.  Check out his post on LITFL.
Conduction goes down functioning anterior fascicle, from endocardium to epicardium (initial small voltage) to remaining myocardium from the anterior/superior LV towards the inferior/posterior LV resulting in the following changes:
  • Right axis deviation (> +90 degrees)
  • Small R waves with deep S waves in leads I and aVL
  • Small Q waves with tall R waves in inferior leads (II, III, aVF)
This altered conduction takes longer than usual and the delay can be seen on ECG:
  • QRS duration normal or slightly prolonged (80-110ms)
  • Prolonged R wave peak time in aVF
  • Increased QRS voltage in the limb leads
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​Remember it's probably NOT LPFB if you see:
  • No evidence of right ventricular hypertrophy
  • No evidence of any other cause for right axis deviation
  • PE
  • TCA overdose
  • Lateral MI






Copa Cardiogram #73
1 Comment
Roger link
1/13/2021 10:19:00 am

Your the beest

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    Our thanks to Dr. Tim Davie for assembling the Copa Cardiogram each week.  Please follow this link to get to spreadsheet of all Copa Cardiograms.

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  • Home
  • Program
    • Program Director's Message
    • Benefits
    • Clinical Sites >
      • Valleywise Health
      • Arizona Burn Center
      • Phoenix Children's Hospital
      • Banner University Medical Center – Phoenix
      • Toxicology - BUMCP
      • Mayo Clinic Arizona
      • Banner Cardon Children's Medical Center
    • Curriculum >
      • Curriculum
      • Electives
    • Diversity + Inclusion
    • Faculty >
      • Department Chair
      • Faculty Bios
      • Faculty Alumni
      • Program Coordinators
    • Residents >
      • Class of 2021
      • Class of 2022
      • Class of 2023
      • Alumni
    • Students >
      • Adult EM Rotation
      • Ultrasound Rotation
      • Applying to Rotate
      • Applying to the Program
      • Interviews
    • Research
    • Vision & Principles
    • Ultrasound >
      • Ultrasound Director
      • Ultrasound Fellowship
      • Education (internal link)
      • Admin (internal link)
    • Admin Fellowship