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  #1  
Old 09-08-2012
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EKG ECG Question

A 58-year-old man is establishing care with you because his insurance changed. His old records have not yet arrived, but he is complaining of palpitations and lightheadedness,He does not smoke .He drinks 2 beers on weekends.His Father died of myocardial infarction at the age 69 yr and mother died of stroke at the age 70.He has negative history of diabetes so you order the ECG shown in Figure

1.What is the underlying abnormality?
(A) right bundle branch block (RBBB)
(B) left bundle branch block (LBBB)
(C) accelerated junctional rhythm
(D) left anterior fascicular block
(E) intraventricular conduction delay

2. Which of the following is the most likely problem
associated with this pattern?
(A) congenital heart disease
(B) severe aortic valve disease
(C) hypokalemia
(D) atrial septal defect (ASD)
(E) VSD

ECG Question-ekg-2.jpg
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Please add reasoning.
Thank you
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Old 09-08-2012
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Answe
1 B
2 D
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Old 09-09-2012
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ECG is important ! TRY TRY TRY
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Old 09-09-2012
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I say B and B... Aortic stenosis can cause LBBB
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Old 09-09-2012
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I think its
B
B
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Old 09-09-2012
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If it LB BB....Its ASD septum primum type...Which is associated with conduction problem.

But I am not seing the W pattern in V1. which is typical of LBBB.

Here There is poor R wave progression from V1 to V6. Deeep s wave ..

I doubt its ) left anterior fascicular block ..

Again ASD
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Old 09-09-2012
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Answer B and B

The prolonged, negative QRS vector anteriorly (V1−V3) and wide notched R waves in V5 and V6 are characteristic for LBBB. In RBBB, there is an rSR’ complex in V1 and QRS pattern in V6. Accelerated junctional rhythm would not have P waves. Partial blocks, such as left anterior fascicular block, generally do not prolong the QRS duration substantially, but are associated with shifts in the frontal plane QRS axis (left axis deviation). With intraventricular conduction delay, the QRS is between 100 and 120 ms. LBBB is a marker of one of four conditions:severe aortic valve disease, ischemic heart disease,
long-standing hypertension, and cardiomyopathy. RBBB is seen more commonly than LBBB in patients without structural heart disease, although RBBB also occurs with congenital heart disease and ASD or valvular heart disease. Hyper- but not hypokalemia may cause intraventricular conduction delay. Myocarditis does not usually lead to LBBB.
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