LBBB: Primary T Wave Changes
Report:
Sinus rhythm 65/min
First degree AV block
PR 0.28â
Left bundle branch block
Primary T wave changes 2, 3 and aVF
Comment:
LBBB always causes repolarisation changes directed opposite the main QRS deflection, especially its terminal half. They are not reported because they are the expected consequence of the abnormal depolarisation (secondary changes, like with VEBs or anomalous complexes). When they are concordant with the main or late QRS deflection, they constitute evidence for a myocardial lesion independent of the conduction defect â they are primary changes and should always be noted.
In this case the patient had chronic ischæmic heart disease; the changes noted in the inferior leads persisted over at least 3 months (below,Fig 61a) and probably longer.
61a. Persistent primary T wave changes in the inferior leads.
62. 51 year old man with chest pain and normal-looking ECG.
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