Abstract

DE MICHELI, Alfredo; MEDRANO, Gustavo A.  and  ITURRALDE-TORRES, Pedro. Uncomplicated and complicated myocardial peripheral blocks. Arch. Cardiol. Méx. [online]. 2009, vol.79, suppl.2, pp.3-12. ISSN 1665-1731.

Septal necrosis + peripheral left blocks. Because of an extensive septal necrosis, the manifestation of the initial ventricular activation forces decreases in the precordial leads. With left bifascicular block (LASB + LPSB), the first ventricular activation forces become more evident and the electrical signs of septal necrosis can be concealed. In the presence of a trifascicular block, the manifestation of the first ventricular electromotive forces diminishes again and the electrical signs of septal necrosis become evident once more. Small Q waves are present in leads V₁ to V₄. Extensive anterior necrosis + left peripheral blocks. This necrosis is manifested by QS complexes from V₂ to V₆. An associated left bifascicular block reduces the electrical manifestation of dead tissue: QS complexes persist only in V₃ and V₄. In turn, a coexisting trifascicular block causes the presence of QS complexes from V₂ to V₅. Posteroinferior necrosis + left peripheral blocks. Electromotive forces of the ventricular activation shift upward, due to a posteroinferior necrosis, and QS or QR complexes are recorded in leads aVF, II and III. An associated left bifascicular block displaces the main electromotive forces downward, posteriorly and to the left, due to a delay of the posteroinferior activation fronts. The ventricular complexes become positive and wider in all leads, reflecting the potential variations of the inferior portions of the left ventricle: aVF, II, III, sometimes V₅ and V₆. Consequently, the electrical signs of necrosis are reduced or abolished Right ventricular peripheral blocks do not conceal the electrocardiographic signs of univentricular and biventricular dead myocardium.

Keywords : Uncomplicated left ventricular peripheral blocks; Complicated left ventricular peripheral blocks.

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