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| __NOTOC__
| | #redirect:[[Right bundle branch block]] |
| {{Right bundle branch block}}
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| {{CMG}} {{AE}} {{CZ}}
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| ==Overview==
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| 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.
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| ==ECG==
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| * The heart rhythm must be supraventricular in origin
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| * The QRS axis can be either normal, or right or left axis deviation may be present.
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| * The QRS duration must be = or > 120 ms
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| ** 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.
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| ***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.
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| * There should be a terminal R wave in lead V1-V3R (e.g., R, rR', rsR', rSR' or qR')
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| ** 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.
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| * There should be a slurred S wave in leads I and V6. This represent left ventricular activation.
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| ** 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.
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| 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]].
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| == EKG Examples==
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| {| align="center"
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| |-valign="top"
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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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| {| align="center"
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| |-valign="top"
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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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| |-valign="top"
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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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| |-valign="top"
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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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| {| align="center"
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| |-valign="top"
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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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| {| align="center"
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| |-valign="top"
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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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| {| align="center"
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| |-valign="top"
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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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| {| align="center"
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| |-valign="top"
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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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| |-valign="top"
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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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| |-valign="top"
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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==
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| {{#ev:youtube|EJUQKaDeAXg}}
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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