AHLI KUMPULAN:

NIK NURULINDA AMIRA

NUR SHUHADA
NUR WAHIDA
NURRAYATI
RAIDAH
Findings:
1 The duration of the QRS complex is 0.12 secs or greater in limb leads
2 No Q wave is seen in leads I, aVL, and V6.
3 Broad slurred R in V6 with absent q, depressed ST segment and inverted T
wave. Tall R wave is seen in lead V6.Usually a broad slurred R in I and avl
4 Prominent QS pattern is observed in lead V1 with or without a small initial R
wave. Deep S wave in V1-V2
"The three electrocardiographic criteria with independent value in the diagnosis of
acute infarction in these patients were an ST-segment elevation of 1 mm or more
that was concordant with (in the same direction as) the QRS complex; ST-segment
depression of 1 mm or more in lead V1, V2, or V3; and ST-segment elevation of 5
mm or more that was disconcordant with (in the opposite direction from) the QRS
complex."
 Right Bundle Branch Block

1.
For complete RBBB the duration of the QRS complex is >0.10 seconds.With
incomplete RBBB an rSR' pattern will be seen in lead V1 but the QRS duration will
be within the limits of normal.

2.
An rSR' or rR' pattern, with the initial r wave less than the R' or r', in leads V1
through V3 may be present. In leads I and V6 the S wave is wide.
3. The QRS axis may be normal or there may be right or left axis deviation.

4. The T wave is almost always inverted in lead V1 and may be inverted in V2. In the
other precordial leads, and in the limb leads, the T wave is directed opposite to
the terminal portion of the QRS complex.
The QRS complex represents ventricular depolarization via the AV
node, the bundle of His and the bundle branches
The normal QRS complex should last at least 0.08 seconds (2 small
boxes wide) but no more than 0.1 seconds (2 1/2 small boxes wide).
If it is shorter than 0.08 seconds then ventricular systole is occurring too rapidly.
If it is longer than 0.12 seconds (3 small boxes) this may indicate a b
undle branch block. The R-wave may be "squared off" at the apex or may have
two peaks (R and R') closely attached indicating a slower transmission of impulses
through one of the bundle branches. In reality there are two QRS complexes, a
right and left side, slightly out of phase but which appear as one.
In the case of premature ventricular contractions (PVC's) resulting from ectopic
ventricular foci, the R-waves may appear like the R-R' of a bundle branch block
often resulting in a series of very wide QRS complexes, sometimes with square-
topped R-waves. If these occur rapidly (i.e. over 100 beats per minute) it is referred
to as ventricular tachycardia. Should a PVC fall on a T-wave, serious
dysrhythmias can occur, since the T-wave represents repolarization of the ventricle.
If a PVC should occur when the ventricle is only partially repolarized, a new systolic
contraction can be activated. This or several similar types of episodes can result in
ventricular tachycardia which can then progress to ventricular fibrillation which is
fatal if left untreated.
Heart Rhythm Detection
Tool  

Escape atrial rhythm with bundle branch block

Intraventricular conduction blocks - Left / Right Bundle Branch Block
Left and Right bundle branch blocks (HIS bundle) cause ventricular conduction to
be slowed. On the ECG this can be seen as a widening of the QRS complex.
Blocks can be complete or incomplete. Can sometimes be seen in healthy
people. Can be caused by a number of diseases such as blunt thoracic trauma,
hypertension, coronary sclerosis, lung emboli.

RIGHT BUNDLE BRANCH BLOCK

LEFT BUNDLE BRANCH BLOCK
Bifascicular block RBBB and LAFB (right bundle branch block and left anterior
fascicular block).

Four cases of an R wave taller than an S wave in V1 (normally R wave always <
S wave in V1.
Right bundle branch block.
Right ventricular hypertrophy.
Posterior wall myocardial infarction.
Wolff-Parkinson-White.
fascicular blocks are blocks of part of the left bundle, either the posterior or
anterior division:

Figure 38: Divisions of the bundles.

Anterior fascicular block - the most common.
You will see left axis deviation (-30 to -90) and a small Q wave
in lead I and an S in lead III (Q1S3). The QRS will be slightly
prolonged (0.1 - 0.12 sec).

Figure 39: Anterior fascicular block.

Posterior fascicular block - less common.
You will see right axis deviation, an S in lead I and an Q in lead III (S1Q3). The
QRS will be slightly prolonged (0.1 - 0.12 sec).

Figure 40: Posterior fascicular block.

Bifascicular block.
This means two (2) of the three (3) fascicles (in diagram) are blocked. The
most important example is a right bundle branch block and a left anterior
fascicular block. Watch out for this. Only one fascicle is left for conduction,
and if that fasicle is intermittently blocked, the dangerous Mobitz 2 is set up!

Figure 41: Right bundle branch block and left anterior fascicular