ECG of patient with RBBB + LBBB
ECG of patient with RBBB + LBBB
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ECG Description : * The ECG during hospitalization registered sinus rhythm, * AV block 2nd degree. wave conduction  to the ventricles - 4: 2 (2 in 2).  * The sharp deviation of electrical axis of heart toward left. * The morphology of the QRS complexes we evaluate as  LBBB  + RBBB (pronounced R-wave in the right pectoral, the V1 complex QRS - rSR '+ EOS sharp deviation to the left (sign of  both side bundle branch block )). * Changing ST-T we consider the secondary, as a result of violations of intraventricular conduction.
 artificial bi-polar pacemaker
artificial bi-polar pacemaker
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*Patient with  high-grad  2nd degree AV block, as treatment  artificial bi-polar pacemaker is implanted . ECG Description :   *Regime  VVI (single chamber pacemaker electrode implanted in the right ventricle, robot mode - "on demand".) *ECG - rate pacing, effective stimulation, the frequency of 60 beats. / Min, (isolated complexes of its own rhythm) *Please notice carefully  that our usual stimulation pacemaker spikes on an ECG that can not be seen , Because  in this case implanted pacemaker is bipolar - a spike of stimulation will be low amplitude or even imperceptible. In this case, the stimulated areas - it complexes with LBBB morphology.
AV- BLOCK II DEGREE, Mobitz 1
AV- BLOCK II DEGREE, Mobitz 1
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ECG of 82 year old patient, suffering from chronic heart disease, complain: 'disruption' of heart. ECG Description: Sinus rhythm, irregular, 57 BPM, AV-block II Degree, Mobitz 1. Left axis deviation (maximum positive QRS complex- in aVL) Blockage of anterior branch of left bundle branch. This can be proved by following statements:- Axis deviation to left. Small Q and LARGE R wave in lead I and aVL (complex type qR). Small R and deep S in leads II, III,and aVF (complex type rS).   Wenckebach periods are clearly visible. PQ interval is increasing continuously, and it has increased upto 0.34 seconds, and then P is not followed by the QRS complex (which can be seen on every leads after three set)
Left bundle branch block. The blockade of the anterior branch of left bundle branch
Left bundle branch block. The blockade of the anterior branch of left bundle branch
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ECG of 79 year old patient. The Q-history of myocardium infarction. Sinus rhythm, regular, heart rate 88 beats / min. Left axis deviation. The blockade of the anterior branch of left bundle branch (angle  α> - 60 °, in this case, the angle α  ≈  -100 °) Right bundle branch block (high R-wave after a pathological Q in the right chest leads; broadened S wave in the left precordial leads) Scarring of anteroseptal region of the left ventricle (pathological Q wave in leads V1-V2) 
Right bundle branch block, left anterior bundle branch block, hypertrophy of RV
Right bundle branch block, left anterior bundle branch block, hypertrophy of RV
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Male, 63 years, complaints of pain in chest and heart area arising after walking 400 meters. The symptoms appeared after suffering from acute respiratory viral infection. On CVG - multivessel atherosclerotic disease with hemodynamically significant stenoses.  ECG description: Rhythm: sinus, regular; Frequency rate: 58 bpm; PQ- 0,16 sec, QRS- 0,16 sec, QT- 0,40 sec; axis deviation to the left (the angle α -400)  Right bundle branch block In leads III, V1,and V2 present QRS complex of rSR-type, M-shaped In leads  I, aVL, V5-V6 present broaden QRS,  and lead II shows broaden and notched S wave An increase in the QRS duration more than 0.12 seconds V1 lead show ST segment depression with convex, facing upward Combination with left anterior bundle branch block (left axis deviation -40o) Hypertrophy of the right ventricle myocardium (RV1˃7mm.) with its systolic overload (downslope ST depression in V2-V4)  
Bi-fascicular Block (both bundle branch block  = LBBB+RBBB)
Bi-fascicular Block (both bundle branch block = LBBB+RBBB)
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ECG of a  85 years old patient, hospitalized because of intense chest pain   ECG Description : *Sinus rhythm, right, sinus tachycardia, heart rate ≈ 115 beats / min. *Electrical axis of heart deviated toward left  *Acute focal changes anteroseptal area of the left ventricle (Q-myocardial infarction) - a pathological Q in the V1-4, ST-segment elevation in the same leads. *Blockade of RBBB (high R following the stalemate. Q in the right chest leads, broad S wave in the left precordial leads) *The blockade of the anterior branch of left bundle branch . (Electrical axis of heart is sharply deviated to the left - the angle α ≈ - 95 °)
Atrial fibrillation. Signs of right ventricular hypertrophy
Atrial fibrillation. Signs of right ventricular hypertrophy
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ECG patients 56 years of long-term COPD   ECG description : Non sinus rhythem with  atrial fibrillation, trachycardia  HR ≈ 130 bpm Electical exis of heart shifted to left LBBB(anterior branch). (angle α ≈ -65 °) Signs of right ventricular hypertrophy (Rv1> 7 mm, Rv1 + Sv5> 10.5 mm, the absence of S wave in V1-V2, negative T wave in the right precordial leads) We can also suspected left ventricular hypertrophy (quite pronounced R wave in the left chest leads, which are not usually characteristic of an isolated GPZH, ST-T changes in the left chest leads) RsR 'complexes at V2 probably due GPZH and suggest a slowing of the right ventricle. GPZH was confirmed by echocardiogram, it was also diagnosed with severe pulmonary hypertension
AV block - II degree . periodicals with Samoilov-Wenckebach (Mobitz - I)
AV block - II degree . periodicals with Samoilov-Wenckebach (Mobitz - I)
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ECG of 68 years old patient , complaints about the disturbance of the working of heart  .   DESCRIPTION :- * Sinus rhythm, irregular, heart rate 75-41 beats / min * Electrical axis of heart - Left deviation ( anterior left bundle branch ) (angle α≈ -50 °). * AV block 2nd degree.( Mobitz -I) , Samoilova-Wenckebach periodicals - 5: 4 - 3: 2  * a gradua lengthening of PQ-interval, from one complex to another, Until the AV-conduction  becomes impossible and ventricular contraction drops. After the dropped QRS complex , AV conduction restores and this phenomenon periodically  repeats.  
Фибрилляция предсердий. БПВЛНПГ. БПНПГ. Рубцовые изменения нижней стенки ЛЖ
Фибрилляция предсердий. БПВЛНПГ. БПНПГ. Рубцовые изменения нижней стенки ЛЖ
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ЭКГ пациента 66 лет. В анамнезе инфаркт миокарда 3 года назад. Ритм несинусовый, неправильный, фибрилляция предсердий, нормосистолический вариант, ЧСС ≈ 90 уд/мин. ЭОС отклонена влево ( угол α > -45°) БПВЛНПГ ( угол α > -45°) БПНПГ ( М-образные комплексы QRS в V1-V3, уширенный S в V4-V6) Вероятно рубцовые изменения по нижней стенке ЛЖ (комплексы QS в III, aVF)
Фибрилляция предсердий, высокая частота. Блокада ПВ ЛНПГ
Фибрилляция предсердий, высокая частота. Блокада ПВ ЛНПГ
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ЭКГ больного, перенесшего Q-передне-распространенный инфаркт миокарда около двух месяцев назад. Беспокоит выраженная одышка, достигающая степени удушья в ночные часы. Длительно болеет гипертонической болезнью; много лет - фибрилляция предсердий.   Описание ЭКГ: Фибрилляция предсердий с частотой сокращения желудочков ~115-210 в минуту (в среднем 160 в минуту). Отклонение ЭОС влево (максимальная суммарная амплитуда QRS в aVL, косплекс в отведении II - отрицательный) - обусловлено блокадой передней ветви ЛНПГ. Рубцовые изменения в передне-распространенной области (комплекс QS в V1-V4, снижение омплитуды R V5-V6) - последствия ИМ двухмесячной давности. Признаки вохможной гипертрофии/систолической перегрузки ЛЖ (косонисходящий ST и отрицательный Т в I, aVL, V5-V6).  
Гипертрофия левого и правого предсердий
Гипертрофия левого и правого предсердий
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ЭКГ пациента терминальной стадией рака легких. В анамнезе - инфаркт миокарда. Ритм синусовый, правильный, 88 ударов в мин. Отклонение ЭОС влево, блокада передней ветви ЛНПГ. Рубцовые изменения в передне-перегородочной области ЛЖ (комплекс QrS в V1, сниженная амплитуда R в V2-V4). Признаки патологии обоих предсердий - ЛП и ПП (амплитуда Р=0,3 мВ, "двухступенчатый" Р, пограничная ширина Р ~120 мсек.) - как-бы сочетание P-mitrale + P-pulmonale. Вероятные признаки гипертрофии ПЖ (комплекс RSR в V2, отрицательные ST-Т в правых грудных отведениях V1-V3, глубокие S в левых отведениях V5-V6), косвенно в пользу гипертрофии ПЖ говорит и увеличение ПП. Подробнее...
 
 
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