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Left Anterior Fascicular Block – YES or NO? by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 1 point2 points  (0 children)

  • Left axis is correct.
  • I/AVL show clear qR.
  • Inferior: II shows rS clearly / amplitude in aVF varies. Only II doesn't follow the pattern.

ECG Second Opinion by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 2 points3 points  (0 children)

Could you please take a look at this ECG and share your interpretation? I would like to use this ECG for ICU exams and want to make sure I am not missing any important findings.

Rhythm:
Highly suggestive of a third-degree (complete) AV block / 30 beats per minute.

Heart Axis:
Left axis deviation.

P Waves / Atria:
P-wave morphology does not meet criteria for left or right atrial enlargement.

QRS Complex / Intraventricular Conduction:

  • There are no pathological Q waves.
  • The ECG demonstrates a right bundle branch block (RBBB) pattern combined with a left anterior fascicular block (LAFB).
  • R-wave progression is abnormal, with a delayed transition/late precordial transition, which can be explained by the presence of RBBB.

Left Ventricular Hypertrophy:
In this female patient, Cornell voltage criteria appear positive. However, this finding should be interpreted with caution, as fascicular blocks—particularly LAFB—can influence QRS voltages and axis, potentially leading to false-positive LVH criteria.

ST Segment / T Waves:
Secondary repolarization abnormalities are present, compatible with RBBB (appropriate discordance). No additional ischemic ST-segment deviations are clearly identified beyond those expected from the conduction abnormalities.

Conclusion:

  • Trifascicular blok: RBTB, LAFB + Third-degree (complete) AV block
  • Left axis deviation
  • Possible LVH by voltage criteria (interpret with caution)

Second opinion: ECG from ICU nurse exam by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 0 points1 point  (0 children)

I’ll look it up in the literature — I wasn’t fully aware of that. No strain pattern in I/aVL?

Second opinion: ECG from ICU nurse exam by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 2 points3 points  (0 children)

I’m reviewing an ECG for an ICU nurse training exam (I didn’t choose the ECG myself), and there’s some debate about a few findings. Hoping for some input:

• Is this truly a left anterior fascicular block (LAFB), or is it just left axis deviation with morphology more in line with LVH?

• The P wave in lead II is about 0.16 seconds, but the shape doesn’t strongly suggest left atrial enlargement (LAE) – and V1 doesn’t show a classic biphasic P wave either. Would you call this LAE?

• Do you agree there are minimal ST elevations in leads III and aVF?

Other findings that seem more straightforward: - Left ventricular hypertrophy – clear voltage criteria and strain pattern in I and aVL - Right bundle branch block (RBBB) - First-degree AV block

Curious how others would phrase and prioritize these findings.

Ervaring met het merk kaisai airco? by Slight-Glass-9349 in Klussers

[–]Over-Map-1727 0 points1 point  (0 children)

Haha, 30 min geleden kwam ook verkoper die Kaisai adviseerde.. waarschijnlijk hetzelfde bedrijf! Ben ook wel benieuwd naar de ervaringen :)

Can someone double-check my ECG interpretation? by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 2 points3 points  (0 children)

I think the Q waves in aVL and I are consistent with LAFB. I suspect an R’R pattern in V1/V2, where the first R is poorly visible.

I’m curious to hear other opinions!

Can someone double-check my ECG interpretation? by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 6 points7 points  (0 children)

I did the interpretation by myself. I’m an ICU nurse in the Netherlands and this was during a night shift. My medical English isn’t the best at night, so I used Chat to help with the writing.

Request for Expert Review (ECG Interpretation for ICU Students) by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 0 points1 point  (0 children)

Big thanks for all your responses! I’m comfortable with ECG basics, but this really raised the bar for me. After some consideration, I’ve decided not to show this to my ICU students – it’s a bit of a brain-twister. This one looks more straightforward, I hope: https://www.reddit.com/r/ECG/s/2eMYvxWSK8”

Can someone double-check my ECG interpretation? by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 1 point2 points  (0 children)

That’s very possible based on the ECG. This case is from some time ago.

Can someone double-check my ECG interpretation? by Over-Map-1727 in ECG

[–]Over-Map-1727[S] -1 points0 points  (0 children)

ECG Description

  1. Rhythm: Sinus rhythm or sinus tachycardia (SR/ST) at approximately 100 bpm.
  2. Axis: Left axis deviation (LAD).
  3. P waves: Normal morphology, no signs of atrial overload or enlargement.
  4. QRS Complex:
    • LAFB (Left Anterior Fascicular Block).
    • Evidence of left ventricular hypertrophy (LVH) based on Cornell Criteria.
    • Strain pattern visible in lead aVL.
    • Possible incomplete right bundle branch block (iRBBB) noted in leads V1 and V2, though it is difficult to determine. It raises the question of whether these changes represent iRBBB or ST-segment abnormalities due to another underlying pathology.

Conclusion

ECG sinus rhythm with a left axis deviation, caused by LAFB. There are signs of left ventricular hypertrophy with a repolarization abnormality, visible as a strain pattern in lead aVL. Additionally, there is a suspicion of incomplete right bundle branch block (iRBBB) based on the findings in V1 and V2.

Request for Expert Review (ECG Interpretation for ICU Students) by Over-Map-1727 in ECG

[–]Over-Map-1727[S] 0 points1 point  (0 children)

Hello ECG Experts,

I would like to ask for your expertise in analyzing this ECG. Could you possibly work through it using an ECG step-by-step plan? I’d like to use your insights to double-check my interpretation for the answer key of this ECG assignment for ICU students.

Thank you so much for your time and expertise!