LBBB, Atypical.
Atypical LBBB findings in this case are: 1. Q wave in I and aVL. 2. Larger R wave in V1 and V2. Patient. 76 year old male with history of S/P CABG, ischemic cardiomyopathy, COPD, and remote history of alcohol abuse. Criteria for LBBB
Other abnormalities:
1. QRS duration is > 120 ms.
2. Slurred, broad and notched R wave in left side leads V5, V6, aVL and lead
3. Small or absent initial r waves in right precordial leads V1 and V2, followed by deep S wave.
4. Absent septal q wave in left side leads I, aVL, V5 and V6.
5. Prolonged intrinsicoid deflection of > 60 ms in V5 and V6.
Repolarization change
6. T wave inversion with ST depression in left lateral leads V5, V6, I and aVL
7. ST elevation with upright T wave in right precordial leads V1 and V2.Caution: Findings that may lead to other diagnoses.
• Leads V5 and V6 may not have typical pattern if the electrode placements are not far lateral enough.
• No or small r wave, ST elevation in V1 and V2 and ST depression associates with T wave inversion in left side leads (I, aVL, V5, V6) are expected in LBBB)
