LBBB EKG

Vänstergrenblock (LBBB): EKG vid vänstersidigt

EKG-kriterier för vänstergrenblock. QRS-tid ≥0,12 s. Avledning V1-V2: djup och bred S-våg. Den lilla r-vågen saknas eller är mindre än normalt. Om den saknas registreras ett QS-komplex i V1 och eventuellt i V2 men ytterst sällan i V3 Left bundle branch block (LBBB): ECG criteria and clinical implications. Left bundle branch block (LBBB) is the consequence of anatomical or functional dysfunction in the left bundle branch, causing the impulse to be blocked. Depolarization of the left ventricle will be carried out by impulses spreading from the right ventricle Cardiology, Emergency Medicine. Left bundle branch block (LBBB) is a cardiac conduction abnormality seen on the electrocardiogram (ECG). In this condition, activation of the left ventricle of the heart is delayed, which causes the left ventricle to contract later than the right ventricle

Electrophysiology. In normal cardiac conduction, impulses travel equally down the left and right bundles, with the septum activated from left to right and the formation of small Q waves in lateral leads. In LBBB, conduction delay means that impulses travel first via the right bundle branch to the RV, and then to the LV via the septum Left bundle branch block (LBBB) is an abnormal pattern seen on an electrocardiogram (ECG), which indicates that the cardiac electrical impulse is not being distributed across the ventricles of the heart in the normal way The ECG strip below shows normal sinus rhythm, then atrial fibrillation with a rapid ventricular response develops. With the faster heart rate, the QRS complex morphology changes to that of a LBBB

Left bundle branch block (LBBB) In very very simple terms, LBBB is just the opposite of RBBB. So, the right ventricle depolarises as normal BUT the left ventricle depolarises much slower Köp boken PAM direkt på Bokus. Klicka här för att beställa! Sjukdomar » Hjärt- Kärlsjukdomar » Retledningshinder - Vänstergrenblock. LBBB. (Left bundle branch block). Retledningshinder - Vänstergrenblock. LBBB. (Left bundle branch block). ICD-10: I44 - Patologiskt EKG ; Bifascikulärt block (RBBB + LAH) ex 3 - Sinusrytm 87 slag/min - Normal PQ-tid 0,18 sek - Högersidigt skänkelblock (RBBB) samt extrem vänsterställd elektrisk axel minus 92 grader således vänstersidigt främre fascikelblock (LAH) d v s bifascikulärt block - Patologiskt EKG ; Bifascikulärt Block (RBBB + LPH) - Sinusrytm 56 slag/mi

EKG-kriterier för högergrenblock. QRS-tid ≥0,12 sek. Avledning V1-V2: Kammarkomplexet blir M-format. Mer specifikt ses antingen rsr', rsR' eller rSR'-mönster (oftast rSR'). Ibland når inte S-vågen hela vägen ner till baslinjen. Andra R-vågen är nästan alltid större och bredare än första r-vågen. Avledning V5, V6, I, aVL: Bred S-vå If you have a left bundle branch block, you will need a full evaluation. Tests that can be used to diagnose a bundle branch block or its causes include: Electrocardiogram (ECG or EKG). An ECG records the electrical impulses in your heart using wires attached to the skin on your chest and sometimes your limbs EKG of Incomplete Left Bundle Branch Block Incomplete left bundle branch block is less common than complete left bundle branch block 3 . The initial depolarization of the left ventricle occurs via impulses spreading from the right ventricle, but after a while the impulse passes the block in the left bundle branch and executes the remaining ventricular depolarization 3 This lecture describes the classic ECG findings that are associated with left bundle branch block (LBBB).0:29 QRS Prolongation0:52 Left Lead QRS Morphology (..

Left bundle branch block (LBBB): ECG criteria, causes

1. Vasen haarakatkos (LBBB) Keskeistä. Sydänfilmissä eli EKG:ssa uutena havaittu vasemman kammion tai oikean kammion haarakatkos ei yleensä sellaisenaan aiheuta mitään oireita, mutta on syytä tutkia ainakin ultraäänellä eli kaikututkimuksella
2. A simple explanation to explain both left and right bundle branch block with ECG examples.www.MedicineStepByStep.comKey Bullet Points from Bundle Branch Bloc..
3. Back in 1996, Dr. Sgarbossa created criteria for diagnosing a STEMI on a 12 lead in the presence of a LBBB. There was three criteria in that meant there was a STEMI: Concordant ST depression that is greater than 1 mm in V1-V3. Concordant ST elevation that is greater than 1 mm in any lead. Greater than 5 mm of elevation in a discordant complex
4. In left bundle branch block, there is a problem with the left branch of the electrical conduction system. The electrical signal can't travel down this path the way it normally would. The signal still gets to the left ventricle, but it is slowed down, compared to the right branch. Because of this, the left ventricle contracts a little later than it normally would
5. Doctors usually diagnose LBBB by using an electrocardiogram (EKG). This is a painless test that involves placing stickers called leads around your chest. The leads conduct electricity
6. Patients with a suspected myocardial infarction (MI) in the setting of a left bundle branch block (LBBB) present a unique diagnostic and therapeutic challenge to the clinician. A diagnosis of MI with electrocardiogram (ECG) is especially difficult in the setting of LBBB because of the characteristic ECG changes caused by altered ventricular depolarization

ECG criteria for right bundle branch block (RBBB) QRS duration ≥0,12 seconds. Leads V1-V2: The QRS complex appears as the letter M. More specifically, the QRS complex displays rsr', rsR' or rSR' pattern (rSR' is the most common, exemplified in Figure 1). Occasionally the S-wave does not reach the baseline Bundle branch block. Electrical impulses that cause your heart to beat (contract) start in the heart's upper right chamber (right atrium) and travel to the lower chambers (ventricles). In bundle branch block, the pathway these impulses follow is delayed or blocked. The pathway includes two branches — the left and the right bundles In LBBB, the normal direction of septal depolarization is reversed (becomes right to left), as the impulse spreads first to the RV via the right bundle branch and then to the left ventricle via the septum. This sequence of activation prolongs the QRS duration to ≥120 ms and eliminates the normal septal Q waves in the lateral leads Figure I: EKG showing LBBB. The ECG shows wide QRS complexes (> 120 ms), increased intrinsecoid deflection time (80-120 ms), rS complexes inV1-V2, and loss or large reduction of Q waves in leads I and aVL. Likewise, repolarization forces mirror the electrical abnormality induced by the sequential activation of the two ventricles ECG Diagnostic criteria. QRS duration > 120ms. RSR' pattern in V1-3 (M-shaped QRS complex) Wide, slurred S wave in lateral leads (I, aVL, V5-6) RBBB: Right Bundle Branch Block. V1: RSR' pattern in V1, with (appropriate) discordant T wave changes. V6: Widened, slurred S wave in V6. Associated features incude: Appropriate discordance.

Left bundle branch block - Wikipedi

Figure 4 - Left Bundle Branch Block (LBBB) In LBBB, the opposite occurs. Here, the left bundle branch no longer conducts electricity. The electrical impulse thus enters right bundle branch, and is carried to the right ventricle (first panel). From there, it finally spreads to the left ventricle (second panel) The presence of a left bundle branch block (LBBB) on EKG can make recognition of an acute ST segment elevation myocardial infarction (STEMI) difficult. While a patient with a new or presumed new LBBB and either hemodynamic instability or signs of heart failure should be transferred for percutaneous coronary intervention or coronary artery bypass, patients with chronic LBBB present more.

Left Bundle Branch Block (LBBB) • LITFL • ECG Library

Left bundle branch block (LBBB), a pattern seen on the surface electrocardiogram (ECG), results when normal electrical activity in the His-Purkinje system is interrupted ( figure 1 ). The normal sequence of activation is altered dramatically in LBBB, with a resultant characteristic appearance on the ECG ( waveform 1 ) Blokáda levého raménka Tawarova - EKG. Blok levého raménka Tawarova (BLRT) se také označuje jako Left Bundle Branch Block ( LBBB ). Jedná se o relativně častý název, zejména u starších pacientů a kardiaků. Obraz na EKG může být relativně divoký. Ve svodu V1 (a někdy i ve V2-V3) může být přítomno QS (které může být následováno ascendentní elevací. 29. 30. Information. This quiz contains several brief medical histories and their matching ECGs. For each question, you should check between 0 to 4 diagnoses. If the blood pressure is not specified, it means that it is in the normal range. Remember: Do not use your browser's back button

EKG-kriterier Kriterier för ST-höjning. Ny ST-höjning (i frånvaro av tecken på vänsterkammarhypertrofi och LBBB) i två angränsande avledningar ≥1 mm, förutom i avledning V2-V3 där följande gäller: ≥2,5 mm hos män <40 år, ≥2 mm hos män >40 år och ≥1,5 mm hos kvinnor Sgarbossa's Criteria. An EKG scoring system was developed, and the Sgarbossa's criteria were assessed on patients from the GUSTO-1 trial. These patients were scored from 0-5 for the presence of LBBB in the context of an acute myocardial infarction. Three criteria are included in the scoring system, and a score of at least 3 points is required to make the diagnosis of STEMI

Why Left Bundle Branch Block Is Importan

• INTRODUCTION. Left bundle branch block (LBBB), a pattern seen on the surface electrocardiogram (ECG), results when normal electrical activity in the His-Purkinje system is interrupted ().The normal sequence of activation is altered dramatically in LBBB, with a resultant characteristic appearance on the ECG ().LBBB most often occurs in patients with underlying heart disease and may be.
• How LBBB works. In LBBB you will see wide complexes with a negative (sometimes W shaped) complex in V1 and an M pattern in V4 -V6 and T wave inversion in the anterolateral leads. The T wave inversion is due to abnormal repolarization (after abnormal depolarization) rather than ischaemia. From first principles
• LBBB. (Left bundle branch block). Retledningshinder - Vänstergrenblock. LBBB. (Left bundle branch block). ICD-10: I44. Diagnos. Klumpigt QRS (≥ 120 ms) i V1-2 samt klumpig R utan föregående Q i V4-6, I och aVL som också har diskordanta ST-T-förändringar (fig. 7)

Figure 2 shows the ECG of another patient with LBBB and an acute TIMI-0 LAD occlusion. There is no concordant STE or STD. There is discordant STE in V1-V5 which meets the MSC criterion in all 5 consecutive leads, but meets the Barcelona algorithm criterion only in lead V5, because V1-V4 have predominant S waves which are greater than 6 mm in amplitude, whereas the S wave in V5 is exactly 6 mm EKG-bilden kan likna den vid vänsterkammarhypertrofi [ Inkomplett vänstergrenblock - EKG med typisk grenblocks morfologi men med en QRS-duration < 120 ms ] Vid LBBB ses ett M-format komplex i vänstersidiga bröstavledninga EKG-fynd som talar för SVT: Typiskt LBBB eller RBBB; Jämför vilo-EKG med EKG vid takykardi Om QRS-komplexen i vilo-EKG är identiska med dem vid breddökad takykardi är VT mindre sannolikt. Patienter med känt grenblock i vilo-EKG eller annan känd orsak till breddökat QRS (t ex kardiomyopati) kan ha ett identiskt QRS-komplex vid takykardi

In the presence of LBBB, however, this septal activation is reversed, which eliminates these normal septal Q waves. The right to left depolarization of the myocardium produces deep S waves in the right praecordial leads (V1-V3) and tall R waves in the lateral leads (I, V5 and V6) Functional LBBB may occur at faster heart rates (3 phase block, e.g. during supraventricular tachycardia) or even during bradycardia (4 phase block). In this case, heart rate was nearly the same (65 bpm) with and without LBBB making the hypothesis of rate-dependent block unlikely [3] Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95% CI: 1.86.

Left Bundle Branch Block (LBBB) ECG Review - Criteria and

1. Sgarbossa's criteria are a set of electrocardiographic findings generally used to identify myocardial infarction (also called acute myocardial infarction or a heart attack) in the presence of a left bundle branch block (LBBB) or a ventricular paced rhythm.. Myocardial infarction (MI) is often difficult to detect when LBBB is present on ECG. A large clinical trial of thrombolytic therapy for.
2. In case of a left bundle branch block (LBBB), infarct diagnosis based on the ECG is difficult.The baseline ST segments and T waves tend to be shifted in a discordant direction with LBBB, which can mask or mimic acute myocardial infarction
3. Aims: Using a comprehensive large prospective regional ST-elevation myocardial infarction (STEMI) system database, we evaluated the prevalence, clinical and angiographic characteristics, and outcomes in patients with ischemic symptoms and new or presumed new left bundle branch block (LBBB). We then tested a new hierarchical diagnosis and triage algorithm to identify more accurately new LBBB.
4. It is important to remember that LBBB and paced rhythms DO NOT obviate the ability to diagnose acute coronary occlusion. It is clear that the Sgarbossa and modified Sgarbossa criteria are very specific (but not sensitive) and may be used to help identify occlusion MI in patients with LBBB or paced rhythms. This is supported by the ESC guidelines (Ibanez et al., 2017)
5. Definitions in LBBB: Concordance: ST segment is in the same direction as the majority of the QRS Discordance: ST segment is in the opposite direction to the majority of the QRS Rule of appropriate discordance: ST segments in all leads should be discordant to the majority of the QRS. Smith rule: Discordance should be proportional to the QRS, with an ST/S or ST/R ratio no greater than 0.25
6. On average, the net increase in QRS LBBB constituted 92% of the net increase in QT LBBB. A new formula, QT-LBBB = QT LBBB - (0.86 * QRS LBBB - 71), which takes the net increase in QRS LBBB into account, best predicted the QT interval with heart rate corrected QTc in the test set of LBBB ECGs when compared to the baseline value and prior formulae
7. The case this week is on the ECG diagnosis of complete LBBB. While I essentially agree with Dawn's description — I'll offer a slightly different approach that I have used for the past 3+ decades with great success — and which allows me to teach others how to accurately diagnosis RBBB, LBBB and IVCD within seconds — as well as when to suspect that in addition to the conduction defect.

An elevated ST segment and an upright T wave in V6 with a positive QRS is taken as an evidence of myocardial infarction / ischemia in the presence of left bundle branch block (LBBB). Other evidences of myocardial infarction in the presence of LBBB are typical coved ST elevation, prominent R waves in V1 and Q waves in V6 LL - LBBB M - V6. M - V1 RR - RBBB N - V6. With a Left bundle branch block (LBBB), you get W or more accurately V shaped complex (rS) in V1 and M shaped complex (R) in V6

EKG kriterier; EKG med smala kammarkomplex. Ny ST-höjning (i frånvaro av tecken på vänsterkammarhypertrofi och LBBB) i två angränsande avledningar ≥1 mm, förutom i avledning V2-V3 där följande gäller: ≥2,5 mm hos män <40 år, ≥ 2 mm hos män >40 år och ≥1,5 mm hos kvinnor Left bundle branch block (LBBB), incomplete. EKG MD; 11/12/2019; ECG Features. Mean QRS duration between 110-119 ms in adults, between 90-100 ms in children 8-16 years of age, and between 80-90 ms in children <8 years of age; Late QRS complex forces should be negative (i.e. terminal S wave) in V1 New LBBB no longer considered an equivalent of STEMI I rarely post cardiology clinical tips here on EMS1, primarily because my friend Tom Bouthillet , the EKG Yoda, does it better

Infarkttyp (i slut vårdkedja) =2. Om infarkttyp saknas kommer pat räknas som NSTEMI om EKG/QRS vid ankomst inte är 3(LBBB) eller EKG/STT vid ankomst inte är 2(ST-höjning). Pat står inte på Waran vid ankomst enligt startsida, dvs antikoagulantia=0 eller missing. Hur åtgärden mäts: Ett av kriterierna ska vara uppfyllda LBBB: left bundle branch block; see bundle branch block , under block Besides the suggestion to evaluate the JT interval in patients with LBBB as an alternative risk-stratification method in the presence of LBBB , several formulas were developed the last years for avertable estimation of the QT interval , , , , , , ().A different approach in pacemaker recipients is the subtraction of 50 ms of the QTc LBBB as a rule of thumb Bocoran aja, salah satu kepentingan klinis belajar RBBB vs LBBB adalah kalau kamu ketemu pasien nyeri dada spesifik dengan gambaran EKG LBBB, kamu mesti curiga banget dia infark miokard akut, meskipun kamu nggan nemu ST Elevasi, ST Depresi atau T Inversi. Kalau kayak gitu, kamu perlu assess LBBB-nya itu new atau old (Pakai Sgarbossa Criteria)

Right Bundle Branch Block (RBBB) activation of the right ventricle is delayed as depolarisation spreads across septum from left ventricle De initiala delarna av såväl höger- som vänster kammares EKG förlöper därför normalt: rS respektive qR. Höger kammarens depolarisering blir däremot fördröjd, då impulserna får söka sig dit från vänster skänkel genom förhållandevis långsamt ledande arbetsmuskulatur EKG: Bradycardia and LBBB By Zac Wilson | Pearl of the Day | Comments are Closed | 17 April, 2017 | 0 A 75 year-old male with a history of systolic heart failure, hypertension, diabetes, hyperlipidemia, and COPD presents with complaints of shortness of breath to the ED. he presents with this ECG

Bundle Branch Block - EasyEC

But in the outpatient setting the ACC recommend echo: Patients may often be asymptomatic, particularly in the setting of isolated right bundle branch block (RBBB) or fascicular blockCohort studies have generally demonstrated an association between LBBB, but not RBBB, presence and the development of coronary disease and heart failurePatients with RBBB or intraventricular conduction. It's also a good idea to carry a copy of your EKG that shows you have LBBB in case of an emergency, like a heart attack. That way, the doctors and nurses know and can give you the right treatment Vasen haarakatkos (LBBB) Eteis-kammiojohtumisen häiriöt; Kammionsisäiset johtumishäiriöt. Kammionsisäisiä johtumishäiriöitä ovat oikea ja vasen haarakatkos ja haarakekatkokset. Ne liittyvät moniin sydänsairauksiin, mutta voivat olla myös itsenäisiä. Haara- ja haarakekatkokset aiheuttavat kullekin luonteenomaisen EKG-muutoksen AN INTERESTING ECG Prof. Dr. Mageshkumar's Unit . We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads A new formula, QT‐LBBB = QT LBBB - (0.86 * QRS LBBB - 71), which takes the net increase in QRS LBBB into account, best predicted the QT interval with heart rate corrected QTc in the test set of LBBB ECGs when compared to the baseline value and prior formulae. Conclusion

Retledningshinder - Vänstergrenblock

Summary. Electrocardiography is an important diagnostic tool in cardiology. External electrodes are used to measure the electrical conduction signals of the heart and record them as characteristic lines on graph paper (an electrocardiogram; ECG). The interpretation of the amplitude and duration of these lines allows for the assessment of normal cardiac physiology as well as the detection of. A left bundle branch block (LBBB) is a contraindication to exercise stress testing to detect myocardial ischemia. Recall that ischemia cannot be diagnosed on ECG when a LBBB is present form of an LBBB, which may justify his susceptibility for developing an LBBB type of BBR-VT. It is important to recognize BBR as a mechanism of sustained VT in ChHD because it can be cured effectively by catheter ablation of a bundle branch (typically the RBB),1,2 probably one of the easiest techniques for V Making Sense of Sgarbossa's Criteria - Chest Pain and Left Bundle Branch Block - Part 1. Left Bundle Branch Block. Left bundle branch block presents a dilemma for many clinicians in the evaluation of chest pain (or other signs and symptoms of ACS) and it's easy to see why

EKG-atlas, retledningshinder - Internetmedici

• Apr 26, 2019 - Criteria for LBBB and RBBB #Diagnosis #Cardiology #EKG #ECG #RBBB #LBBB #Table #Criteri
• LBBB and RBBB prognosis strength are taking new positions over the time. Both have shown its relation with patient's mortality and prognosis implications. Therefore, in this review, we intend to make an approach of the BBB and its prognosis relevance based on the latest studies about this role
• Blokáda levého Tawarova raménka (BLRT, angl. left bundle branch block, LBBB) je porucha vedení vzruchu myokardem vznikající v důsledku postižení převodního systému srdečního a mající za následek opožděnou depolarizaci (a tudíž činnost) levé komory. Celá levá komora je depolarizována zprava z pravého Tawarova raménka, čímž dochází k rozšíření a morfologické.
• In a LBBB the QRS in V1 will be deflected down from the J-point; remember down for a left turn signal. Reverse R → L Ventricular Depolarization: During a left bundle branch block, the normal direction of septal depolarization is reversed: instead of from left to right (L → R), it is from right to left (R → L) causing a sequential depolarization instead of simultaneous.

Left bundle branch block or LBBB is essentially a blockage of electrical impulses to the heart's left ventricle, which is the lower-left part of the heart ECG Review: Incomplete LBBB? By Ken Grauer, MD. Figure. 12-lead ECG recorded from a 47-year-old man with dyspnea. Is there incomplete LBBB? Clinical Scenario: Interpret the 12-lead ECG in the Figure, obtained from a 47-year-old man who presented with dyspnea Sgarbossa Criteria are very specific and may be used to help identify occlusion MI in patients with LBBB or paced rhythms. This is supported by the ESC guidelines (Ibanez et al., 2017). More recently, Di Marco et al. has also proposed a new Barcelona algorithm the has much greater reported sensitivity and comparable specificity for acute OMI in patients with LBBB Normal sinus rhythm: Nsr is as above and LBBB is left bundle branch block.Neither of these are an emergency and LBBB means you have an electrical conduction change that makes the ekg more difficult to interpret

Högergrenblock (RBBB): Högersidigt skänkelblock - Klinisk

Definition of LBBB. The authors chose a relatively conventional definition of LBBB with the QRS duration >0.12 seconds, QS or rS complex in V1, and an R wave peak time >60 ms in lead I, V5, or V6 along with the absence of a Q wave in these leads. 1 There was no requirement for notching or slurring of the R wave in I, V5, and V6 as in the long‐standing World Health Organization definition of. LBBB, also called left bundle branch block, is a condition in which there is a conduction abnormality in heart. It is important to mention that this abnormal conduction can also be observed and seen in an ECG (electrocardiogram). The condition is characterized by delay in electrical impulses in left ventricle of heart due to which the left. The presence of left bundle branch block (LBBB) on the ECG makes diagnosing left ventricular hypertrophy (LVH) problematic because conduction delays augment electrocardiographic wave (QRS) voltage and disturb repolarization in ways that mimic LVH. However, LBBB and LVH are frequently associated in autopsy studies

Bundle branch block - Diagnosis and treatment - Mayo Clini

Definition of the BARCELONA Algorithm to Diagnose AMI in the Presence of LBBB; The BARCELONA algorithm is positive if any of the following criteria are present: ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity in any ECG lead, thus including either: ST depression ≥1 mm (0.1 mV) concordant with QRS polarity, in any ECG lead LBBB and RBBB were identified according to standard definitions (QRS duration > 120 ms). IVCD was defined overall as QRS 101 to 120 ms irrespective of morphology, or as QRS > 120 ms not identifiable as BBB. The researchers devised a first-of-kind subclassification scheme for IVCD EKG kriterier EKG med smala kammarkomplex Ny ST-höjning (i frånvaro av tecken på vänsterkammarhypertrofi och LBBB) i två angränsande avledningar ≥1 mm, förutom i avledning V2-V3 där följande gäller: ≥2,5 mm hos män <40 år, ≥ 2 mm hos män >40 år och ≥1,5 mm hos kvinnor Stimulering och sensing i såväl förmak som kammare. Synkronisering av förmak och kammare bibehålls. EKG har utseende som vid LBBB. Indikation: AV-block II-III med sinusrytm i förmak. Sjuk sinusknuta med AV-block I eller breda QRS-komplex. Neurokardiogen synkope med kardioinhibition. ICD. Implanterbar cardioverter defibrillator, ICD

Be aware of the fact that LBBB makes the EKG and the stress tests unreliable, or it certainly did in my case. I had complete cardiological workups twice, including the ultrasound, and my heart was deemed strong both times. If you develop OTHER symptoms, even seemingly unrelated ones, seek answers; and think about your heart first LBBB also has a close relation with HF, associated with approximately 25% of the cases, and it is known as a worsen factor of the left ventricular fraction ejection . Diagnosis ECG is considered the gold standard for noninvasive diagnosis of conduction disturbances and arrhythmias If your cardiologist spots LBBB on an EKG, they may run tests to figure out the cause. Unlike RBBB, left bundle blocks are more often a sign of tissue damage. Many of them are the same as RBBB and. Feb 19, 2019 - Left Bundle Branch Block (LBBB) ECG Criteria The ECG criteria for a left bundle branch block include: QRS duration greater than 120 milliseconds Absence of Q wave in leads I, V5 and V6 Monomorphic R wave in I, V5 and V6 ST and T wave displacement opposite to the major deflection of the QRS complex This week we are pleased to introduce our guest writer, Dr. Sukhvinder Singh. He will discuss the role of echocardiography in the presence of Left Bundle Branch Block Dr. Singh is a board certified cardiologist in India with 10 years of experience. He has worked at St. Stephen Hospital and Delhi Heart and Lung Institute and sits on the editorial board of many journals including International.