Case in the Spotlight 2

SPOT case 2  tri block

This ECG demonstrates bi fiscicular block

Right bundle branch block PLUS left anterior hemiblock; this consists of left axis deviation and intial r wave in inferior leads

Consider this approach:  The best time to check the axis is when you find a right bundle block.

In fact everytime you aee a RBBB, it is fairly easy to check for

  • Initial r wave in inferior leads
  • Left axis deviation

Lead 1 = left hand, positive = up

Lead avF = right hand, negative = down

Assessment and Management

  • Cardiac monitored bay and IV access
  • Bloods
  • CXR
  • Referral to cardiology team

Consider admission for telemetry, pacemaker in any patient with bi-fascicular block and syncope