LBBB with Transient Right Axis Deviation: Ischæmic Cardiomyopathy

Report:

Sinus rhythm

Right axis deviation (RAD) + 140o

Left bundle branch block

Comment:

The unusual combination of LBBB and RAD is a surprisingly specific marker of congestive cardiomyopathy29. This patient had CABG following an inferolateral MI; subsequent angiography showed 2/4 LV dilatation and EF 29%.

Later ECGs showed persistent LBBB with normal axis (Fig 50a). The concordant T waves in 1 and V6 represent a primary T wave change, indicative of a myocardial disease additional to the conduction defect.

Fig 50a.

Fig 51. 87 year old man with history of myocardial infarction.

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