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Patient
24-year-old man with no prior history;
Trace
Sinus activity; normal PR, narrow QRS; left anterior fascicular block: left axis, rS pattern in the inferior leads, qR pattern in leads I, aVL, earlier R wave in aVR than in aVL, q wave in V1-V2;
Exergue
A left axis deviation on a narrow QRS in the absence of left ventricular hypertrophy should evoke the presence of an inferior infarction sequela (q wave in inferior leads) or a left anterior fascicular block (rS pattern in the inferior leads).
This patient presents a typical electrocardiographic pattern of left anterior fascicular block.