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| ;For EKG examples of right bundle branch block click [[Right bundle branch block EKG examples|here]]. | | ;For EKG examples of right bundle branch block click [[Right bundle branch block EKG examples|here]]. |
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| ==[[Right bundle branch block EKG examples]]==
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| EKG below is from an elderly woman who had previously undergone surgery for recurrent ventricular tachycardia. She was being treated with Tambacor and metoprolol. The cardiogram shows sinus rhythm with a wide QRS of 159ms consistent with a RBBB and a rightward axis suggesting right posterior hemi-block. The PR interval is slightly prolonged at 2121ms. The poor R wave progression seen best in lead V2 suggests previous anterior wall MI.
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| [[Image:Right bundle branch block.jpg|center|800px]]
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| EKG below is a recording from an older man in the [[surgical intensive care unit]]. He was recovering from a [[motor vehicle accident]] where he sustained a [[chest injury]] from his seat belt. The rhythm is [[sinus rhythm]] with a prolonged p wave duration in lead III( >140ms) and a pronounced terminal negativity in V1 suggestive of left atrial abnormality. The [[QRS]] is wide with a duration of 137ms and a superior and right ward axis. There is an [[RSR]] in V1 and the S wave is greater than the R in V6. This is an unusual pattern for aberrance and is more in keeping with ventricular ectopy. In this case, this appears to be a [[right bundle branch block]] with a possible left posterior hemi-block.
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| Of note, in spite of this conduction disturbance the patient was able to sustain reentrant supraventricular tachycaridas requiring intravenous [[adenosine]] for termination.
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| [[Image:Rbbb1.jpg|center|800px]]
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| {| align="center"
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| | [[Image:RBBB1.png|thumb|The main characteristics of [[Right Bundle Branch Block]] in V1]]
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| | [[Image:ECG RBTB LAtrD.jpg|thumb|[[Right Bundle Branch Block]]]]
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| |}
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| | [[Image:RBBB.PNG|thumb|[[Right Bundle Branch Block]]]]
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| | [[Image:C13.ht13.jpg|thumb|[[Right Bundle Branch Block]]]]
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| |}
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| {| align="center"
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| | [[Image:C14.ht14.jpg|thumb|[[Right Bundle Branch Block]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:C15.ht15.jpg|thumb|[[Right Bundle Branch Block]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| |}
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| {| align="center"
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| | [[Image:C16.ht16.jpg|thumb|[[Right Bundle Branch Block]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:C17.ht17.jpg|thumb|[[Right Bundle Branch Block]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| |}
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| | [[Image:C18.ht18.jpg|thumb|[[Right Bundle Branch Block]] with [[First Degree AV Block|first degree AV block]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:C22.ht22.jpg|thumb|[[Right Bundle Branch Block]] with RA hypertrophy. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| |}
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| | [[Image:RBBB_inf_MI.jpg|thumb|Patient with [[RBBB]] and [[Acute MI|inferior MI]]. Note to left axis deviation.]]
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| | [[Image:RBBB_inf_MI_V4R.jpg|thumb|The same patient. Lead V4R. ST elevation shown.]]
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| |}
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| | [[Image:RBBB_inf_MI_baseline.jpg|thumb|The same patient before [[acute MI]] developed. Horizontal axis shown.]]
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| | [[Image:R11.ht36.jpg|thumb|[[Supraventricular tachycardia]] with [[RBBB]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| |}
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| | [[Image:cominf12.jpg|thumb|Old [[Acute MI|Anterior MI]] with [[RBBB]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:cominf19.jpg|thumb|Old [[Acute MI|Inferior MI]] and [[Acute MI|Anterior MI]] with [[RBBB]] and [[LAFB]].]]
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| |}
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| {| align="center"
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| | [[Image:cominf5.jpg|thumb|Old [[Acute MI|Inferior MI]] and [[RBBB]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:c3.htm3.jpg|thumb|[[RBBB]] + [[LAFB]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| |}
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| {| align="center"
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| | [[Image:c19.ht19.jpg|thumb|[[RBBB]] + [[LAFB]] + [[First Degree AV Block]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:c20.ht20.jpg|thumb|[[RBBB]] + [[LAFB]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| | [[Image:c21.ht21.jpg|thumb|[[RBBB]] + [[LPFB]]. <small> [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
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| |}
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| ==Animation of RBBB== | | ==Animation of RBBB== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Criteria for complete right bundle branch block includes: a QRS duration of > .12 seconds, a rSR' pattern with a wide terminal R wave in V1 and a qRS complex with a wide S wave in V6.
ECG
- The heart rhythm must be supraventricular in origin
- The QRS axis can be either normal, or right or left axis deviation may be present.
- The QRS duration must be = or > 120 ms
- For complete RBBB, the patient's age must be taken into account to determine if the duration of the QRS complex is prolonged for the patient's age.
- Maximum QRS durations are 0.07 s for newborns <6 days, 0.08 s for patients aged 1 week to 7 years, and 0.09 s for patients aged 7-15 years.
- There should be a terminal R wave in lead V1-V3R (e.g., R, rR', rsR', rSR' or qR')
- This pattern is present because the initial R wave represents septal activation, the S wave represents left ventricular activation, and the R' represents activation of the right ventricle from the septum and left ventricle.
- There should be a slurred S wave in leads I and V6. This represent left ventricular activation.
- Because transmission of the electrical impulse through the left bundle is normal, this results in normal depolarization of the septum and the left ventricle. As a result, there is an initial R wave in lead I and V1 and the Q wave in V6.
The T wave should be deflected opposite the terminal deflection of the QRS complex. This is known as appropriate T wave discordance with bundle branch block. A concordant T wave may suggest ischemia or myocardial infarction.
- For EKG examples of right bundle branch block click here.
Animation of RBBB
{{#ev:youtube|EJUQKaDeAXg}}
References
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