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Left Bundle Branch Block and Left Anterior Descending Artery occlusion: Serial ECGs then T-wave inversion after reperfusion by Stephen Smith Posted Sun 31 Jul 2011 6:15pm A 50 yo male presented with chest pain.  This ECG was recorded at 0415. There is sinus tachycardia.  There is left bundle branch block (LBBB).  All ST-T complexes are discordant.  However, the ST-T in V1-V4 is excessively discordant: with 6 mm ST elevation, V3 meets criterion 3 of Sgarbossa's criteria (giving 2 points, not enough f ... Read on »
Hyperkalemia in the setting of Left Bundle Branch Block by Stephen Smith Posted Sat 06 Oct 2012 8:20am I'm sorry, but there was an error in the previous post and I had to remove it.  Depending on information received, I may be able to repost it. A dialysis patient presented with vomiting.  He has  known baseline left bundle branch block.  Here is his initial ECG There is left bundle branch block, with a QRS duration of 220 ms a ... Read on »
Left Bundle Branch Block with Less Than 1 mm of Concordant ST Elevation (in the Setting of Hypertrophic Cardiomyopathy) by Stephen Smith Posted Fri 03 May 2013 1:39pm A male in his 60's with a known history of hypertrophic cardiomyopathy (HOCM) presented for chest pain.  He thought  it was "acid reflux," and it started a few hours prior to his presentation to a non-PCI capable hospital.  He denied any associated symptoms.  His pain was not relieved with NTG.  He had an minimally elevated troponin at the refe ... Read on »
“Incomplete” left bundle branch block : Our knowledge is as incomplete as LBBB ! by Dr. Sangareddi V. Medical Doctor Posted Wed 07 Apr 2010 11:13pm LBBB is probably the most important  conduction defect of the heart .When we say LBBB , we visualize a  strikingly  wide bizarre qrs complex . Left bundle even though is considered  a discrete structure , the fascicles  make it a diffusely spread structure. Many varieties of LBBB with various degrees of involvement occur. Talking about ... Read on »
Is this Left Bundle Branch Block? Is there STEMI? by Stephen Smith Posted Fri 27 Dec 2013 10:25am A male 1 ppd smoker in his 50's with no prior cardiac history called 911 because the chest pain and left arm pain, with SOB and diaphoresis,  He callled because the pain was not going away with antacids after 8 hours. Here is the prehospital ECG (time zero), reportedly recorded with chest pain, but this is not certain The first tracing is l ... Read on »
New Left Bundle Branch Block is a poor indicator of coronary occlusion by Stephen Smith Posted Mon 08 Mar 2010 11:19am Case 1: A 55 yo male with a history of hypertension but no MI or CHF presented with 5 days of progressive dyspnea without chest pain. Here is his ECG There is sinus tachycardia with left bundle branch block (LBBB). A previous ECG from one year prior was normal without LBBB. According to the ACC and AHA, new LBBB in the presence of is ... Read on »
Peer Reviewed Lecture: ECG Diagnosis of STEMI-equivalent in Left Bundle Branch Block (20 minutes) by Stephen Smith Posted Thu 10 May 2012 3:00pm This is a lecture for the journal Academic Emergency Medicine, which now publishes lectures that have been peer-reviewed. This is the second one they have published. Thanks to the publisher Wiley Blackwell for making this free to the public. It will also be on the front page of the journal at ECG Diagnosis of Acu ... Read on »
MIA 2012: Smith SW et al. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the S by Michelle Lin Medical Doctor Posted Tue 01 Jan 2013 4:42pm Bottom Line Why It’s Important for Emergency Medicine We’ve been told that you just can’t accurately read cardiac ischemia on an EKG in the setting of a LBBB - even when you apply the Sgarbossa criteria. Its specificity is great (~98%), but with a sensitivity of around 20%, you’re missing a whole lot of acute MI’s.  ... Read on »
Atypical Left Bundle Branch with acute RCA occlusion by Stephen Smith Posted Fri 14 May 2010 12:47pm This 70 year old woman with a history of left bundle branch block presented with 10 hours of dyspnea. Notice there is QRS widening with a wide upright R wave in lead V6. That the QRS is not similar to V6 in leads I and aVL makes this an atypical LBBB. Nevertheless,, the same rules of concordance and discordance apply: the ST-T complex s ... Read on »
What is the rhythm? And is there new left bundle branch block (LBBB)? by Stephen Smith Posted Sun 27 May 2012 12:16pm A 90 yo with a history of orthostatic hypotension had a near syncopal event followed by chest pain. Chest pain was resolved upon arrival in the ED. His previous ECG was normal. Here is his initial ECG There is a wide complex regular rhythm at a rate of about 80. What is it? Answer below. ... Read on »