?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Exercise-induced+left+septal+fascicular+block%3A+an+expression+of+severe+myocardial+ischemia&rft.creator=Uchida%2C+Augusto+Hiroshi&rft.creator=Moffa%2C+Paulo+Jorge&rft.creator=Riera%2C+Andr%C3%A9s+Ricardo+P%C3%A9rez&rft.creator=Ferreira%2C++Beatriz+Moreira+Ayub&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=The+electrocardiogram+(ECG)+criteria+for+the+left+septal+fascicular+block+(LSFB)+are+not+universally+accepted+and+many+other+denominations+can+be+seen+in+literature%3A+focal+septal+block%2C+septal+focal+block%2C+left+septal+fascicular+block%2C+left+anterior+septal+block%2C+septal+fascicular+conduction+disorder+of+the+left+branch%2C+left+septal+Purkinje+network+block%2C+left+septal+subdivision+block+of+the+left+bundle+branch%2C+anterior+conduction+delay%2C+left+median+hemiblock%2C+left+medial+subdivision+block+of+the+left+bundle+branch%2C+middle+fascicle+block%2C+block+of+the+anteromedial+division+of+the+left+bundle+branch+of+His%2C+and+anteromedial+divisional+block.+During+exercise+stress+test%2C+fascicular+blocks+(left+anterior+and+posterior)+seem+to+indicate+severe+coronary+artery+narrowing+of+left+main+coronary+or+proximal+left+anterior+descending+artery+disease1+and+transient+exercise-induced+left+septal+fascicular+block+has+been+reported+a+few+times2%2C3.%0A%0A++++++++++++++++54-year-old+male%2C+with+a+history+of+essential+arterial+systemic+hypertension%2C+primary+hyperlipidemia+and+six-month+typical+chest+pain+during+exercise+(Class+II+%E2%80%93+Canadian+Cardiovascular+Society)+underwent+an+exercise+stress+test.+During+the+exercise+stress+test%2C+ECG+demonstrated+abrupt+prominent+anterior+forces%2C+an+increase+in+R+wave+amplitude+from+V1+to+V4%2C+extreme+left+axis+deviation+and+minor+ST+segment+depression+in+DII%2C+DIII+and+aVF+(Figure+1).+The+post-exercise+period+showed+progressive+return+of+the+QRS+axis+in+both+frontal+and+horizontal+planes+and+the+ST+depression+worsened+by+1+mm.+Coronary+angiogram+(Figure+2A)+showed+a+critical+proximal+left+anterior+descending+artery+lesion.+An+exercise+stress+test+done+three+months+after+coronary+artery+bypass+surgery+grafting+was+normal+(Figure+2B).+%0A&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.contributor=Ghosh%2C+Joydeep&rft.date=2006-04&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4806%2F1%2Fuchida.htm&rft.format=application%2Fpdf&rft.identifier=http%3A%2F%2Fcogprints.org%2F4806%2F2%2Fuchida.pdf&rft.identifier=++Uchida%2C+Augusto+Hiroshi+and+Moffa%2C+Paulo+Jorge+and+Riera%2C+Andr%C3%A9s+Ricardo+P%C3%A9rez+and+Ferreira%2C+Beatriz+Moreira+Ayub++(2006)+Exercise-induced+left+septal+fascicular+block%3A+an+expression+of+severe+myocardial+ischemia.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4806%2F