Right bundle branch block causes
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Differentiating Right bundle branch block from other Diseases |
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Right bundle branch block causes On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]; Aarti Narayan, M.B.B.S [4]
Causes
Most Common Causes
- Cor pulmonale - chronically increased right ventricular pressure and/or right ventricular hypertrophy
- Coronary heart disease
- Myocardial infarction
- Myocarditis
- Surgery for correction of congenital heart disease is the most common cause of RBBB among children in the United States. This includes surgery for repair of an isolated VSD or another congenital heart disease that includes a VSD (eg, double-chambered right ventricle, AV canal defect, or tetralogy of Fallot). The incidence of RBBB varies and ranges from 25-81% after repair of a VSD to 60-100% after repair of tetralogy of Fallot. The risk of RBBB after surgery varies depending upon the proximity of the VSD to the His-Purkinje system.
- Valvular heart disease
Causes by Organ System
| Cardiovascular | Atrial septal defect, Cardiomyopathy, Cor pulmonale, Coronary heart disease, Hypertension, Lev's disease, Lenegre's disease, Myocardial infarction, Myocarditis, Septal reduction therapy with ethanol ablation in patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction, Surgery for correction of congenital heart disease, Valvular heart disease |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | Familial |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Prenatal exposure to HIV |
| Musculoskeletal / Ortho | Polymyositis |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Acute pulmonary embolism, COPD |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | Blunt trauma |
| Urologic | No underlying causes |
| Dental | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
- Acute pulmonary embolism - acute rise in right ventricular pressures
- Atrial septal defect
- Blunt trauma
- Cardiomyopathy
- COPD
- Cor pulmonale - chronically increased right ventricular pressure and/or right ventricular hypertrophy
- Coronary heart disease
- Familial
- Hypertension
- Lev's disease
- Lenegre's disease
- Myocardial infarction
- Myocarditis
- Polymyositis
- Prenatal exposure to HIV type 1 may cause right anterior hemiblock
- Septal reduction therapy with ethanol ablation in patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction
- Surgery for correction of congenital heart disease is the most common cause of RBBB among children in the United States. This includes surgery for repair of an isolated VSD or another congenital heart disease that includes a VSD (eg, double-chambered right ventricle, AV canal defect, or tetralogy of Fallot). The incidence of RBBB varies and ranges from 25-81% after repair of a VSD to 60-100% after repair of tetralogy of Fallot. The risk of RBBB after surgery varies depending upon the proximity of the VSD to the His-Purkinje system.
- Valvular heart disease
Transient RBBB
- Hyperkalemia - causes depression of the His-Purkinje conducting system
- Mechanical damage during right heart catheterization - observed in 5% of the patients. Resolves when the catheter is removed. Associated LBBB can cause complete heart block in such situations leading to cardiac arrest. A temporary pacemaker is inserted during the procedure in patients with LBBB to prevent sudden cardiac arrest.
- Occasionally following thrombolytic therapy in patients with myocardial infarction and new RBBB
- Pulmonary embolism
- Premature atrial contractions or supraventricular tachycardia may cause a transient form of right bundle branch block. This occurs when a premature impulse is conducted from the AV node to the His bundle while the right bundle branch remains in its refractory period, but the left bundle is not. As a result, conduction down the right bundle branch is delayed or blocked.
- Trauma
Pseudo RBBB Pattern
Some patients with Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy (primary ventricular arrhythmia syndromes) have ECG patterns similar to right bundle branch block but such patterns should not be considered true RBBB.