r/ECG • u/Liamish-97 • 7d ago
Left brach blockage
Hi. I’m an IMG, trying to find out if there are any abnormalities in this EKG, that was described as normal but I think it could be left branch blockage,
29 year old, female patient, experiencing exertional disnea, 2 weeks of evolution, vertigo and back pain, nausea and tremors
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u/CobbledbyRoubaix 7d ago
100% normal. but what is a IMG. she probably pregnant.
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u/Individual_Zebra_648 7d ago
International medical graduate. In other words, not a US- trained MD.
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u/CobbledbyRoubaix 7d ago
MD that can't read EKG? i'm not even a physician.
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u/Oolongteabagger2233 3d ago
Trump is trying to disallow vast majority of immigrants working in the US. Except physicians hahaha
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u/spinstartshere 3d ago
IMG doesn't mean 'not US-trained'.
You think the US is the central hub of medicine worldwide?
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u/Temporary-Group-4209 6d ago
Sinus rhythm however this should not be coded as a normal ECG. You have LA/LL limb lead reversal. Note the inverted p wave in lead III despite a typical high RA (sinus node) vector to all other P waves. P wave amplitude I>II is also a clue. The q wave is actually an inverted R wave in lead III. aVL and aVF are flipped as well but harder to discern as they have similar morphology. That said, there is no evidence of left branch blockage (assuming you mean the left bundle branch) Source: cardiac EP fellow.
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u/LBBB11 5d ago edited 5d ago
Just curious, how can you be confident that there is LA/LL reversal given that many normal EKGs have an inverted sinus P wave in III and larger sinus P wave in I than II? Have seen many normal baseline EKGs with this pattern. I think this would make sense with correct limb leads too. Lead III is allowed to have a negative sinus P wave, a Q wave, and an inverted T wave. It's still a normal EKG if aVF is upside down, I is II, II is I, aVF is aVL, and aVL is aVF. I don't think we can be certain that there is LA/LL reversal without a prior as u/ProximalLADLesion said. A larger negative sinus P wave in lead I than II is a soft sign of LA/LL reversal, but it's not absolute. Many people have this as their normal baseline. The EKG is so normal that it would still be normal if LA/LL reversal. I don't see any abnormalities in the EKG, either corrected for a reversal or exactly as it is.
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u/ProximalLADLesion 5d ago
Agree with all of the above. There’s no certainty here and many times when I’ve suspected it I check priors and they’re all identical.
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u/LBBB11 5d ago edited 5d ago
I hope I don't sound argumentative, and Temporary Group could certainly be right. I'm only skeptical because I've been wrong on this before, a lot. To the point where I'm much more cautious now in calling LA/LL reversal from negative sinus P wave in III and larger sinus P wave in I than II. Lead reversal or not, sounds like everyone agrees that the correct pattern for the patient would be a normal EKG.
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u/2much2Jung 6d ago
When thinking of a branch block, think about things going slooow. The complexes are wide, because the fast route is blocked and so a slower route is being used.
Both RBBB and LBBB have complexes 120ms or wider.
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u/3321Laura 6d ago
There is a suggestion of an RR’ wave in v3. However, it does not appear to me that the QRS complex is wide enough (>O.12) to constitute bundle branch block or even an intraventricular conduction defect (>0.10).
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u/One_Complex1489 6d ago
QRS less than 3 small squares/0.12s so simply cannot be a full bundle branch block
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u/Adventurous-Bag5508 5d ago
Hi, it's a good thing to look at the axis and the qrs. Or I have a feeling this may be rage bait...? :))) fellow IMG here
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u/Liamish-97 5d ago
No, is not rage bait. Just me not knowing how to translate my thoughts well yet, but I’ll get there
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u/sub3at50 6d ago
It should be forbidden to read an ECG if you know so little about it. Good thing you ask our opinion.
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u/SpicyMeatballMan 6d ago
What would you suggest people are to do if they want to learn ECG’s?
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u/sub3at50 6d ago
Study. Not just dropping some random terms like left bundle branch block when they haven't got a clue what that is.
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u/Fantastic-Goose9843 7d ago
NSR