Right bundle branch block EKG examples

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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EKG Examples

Shown below is an EKG 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 159 ms consistent with a RBBB and a rightward axis suggesting right posterior hemi-block. The PR interval is slightly prolonged at 2121 ms. The poor R wave progression seen best in lead V2 suggests previous anterior wall MI.

Right bundle branch block.jpg

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Shown below is an EKG 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.

Of note, in spite of this conduction disturbance the patient was able to sustain reentrant supraventricular tachycaridas requiring intravenous adenosine for termination.

Right bundle branch block 1.jpg

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Shown below is an EKG with an rsr' pattern in leads V1, V2, andV3 depicting a right bundle branch block with left axis deviation.

Right bundle branch block 4.jpg

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Shown below is an EKG with an RSR' pattern in leads V2 and V3 depicting a right bundle branch block with left axis deviation.

Right bundle branch block 5.png

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Shown below is an EKG with an RSR' pattern in leads V1, V2,V3, and aVR depicting a right bundle branch block.

Right bundle branch block 6 .jpg

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Shown below is an EKG with an rSR' pattern in leads III, aVR, aVF, V1, V2, and V3 depicting a right bundle branch block.

Right bundle branch block 7 .jpg

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Shown below is an EKG with an RSR' pattern in leads V1 and V2, and a qRs pattern inV6. There is slurring of the S wave in leads I and V6. All these patterns suggest right bundle branch block.

Right bundle branch block 8 .jpg

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Shown below is an EKG with an rSR' pattern in leads III and V1. There is slurring of the S wavein leads I and V6. These findings are consistent with right bundle branch block.

Right bundle branch block 9 .jpg

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Shown below is an EKG with an RSR' pattern in lead V1, an RSr' pattern in lead V2, and wide QRS complexes in leads V1 and V2 depicting a right bundle branch block. There is also PR prolongation which is constant indicating first degree heart block.

Right bundle branch block 11 .jpg

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Shown below is an EKG with an RSR' pattern in leads V1 and V2 indicating a right bundle branch block. Tall P waves seen in leads II and III indicate right atrial enlargement.

Right bundle branch block 12 .jpg

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Shown below is an EKG with an RSR' pattern in lead V2 suggesting right bundle branch block. There is ST elevation in theprecordial leads suggesting STEMI. Heart rate is less than 60 suggesting bradycardia. There is left axis deviation. In addition, there is PR prolongation which is constant suggesting first degree heart block.

Right bundle branch block 14.jpg

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Shown below is an EKG with an RSR' pattern in leads V1, V2,V3, V4, aVF, and III suggesting right bundle branch block. There is left axis deviation. In addition, the PR interval is prolonged and constant suggesting first degree heart block.

Right bundle branch block 15.jpg

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Shown below is an EKG with an rsR' pattern in leads V1 and V2 suggesting right bundle branch block. The EKG also shows supraventricular tachycardia.

Right bundle branch block 16.jpg

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Shown below is an EKG with an rsR' pattern in leads III and V1, and qR' pattern in leadsV2 and V3 suggesting right bundle branch block. The EKG also shows an old anterior MI.

Right bundle branch block 17.jpg

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Shown below is an EKG with an rsR' pattern in leads III, aVR and V1suggesting right bundle branch block. The EKG also shows an old inferior MI, anterior MI, and LAFB.

Right bundle branch block 18.jpg

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Shown below is an EKG with an rsR' pattern in lead V1 suggesting right bundle branch block. The EKG also shows an old inferior MI.

Right bundle branch block 19.jpg

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Shown below is an EKG with an rsR' pattern in lead V1 suggesting RBBB and there is a left axis deviation suggestingLAFB.

Right bundle branch block 20.jpg

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Shown below is an EKG with an rsR' pattern in lead V1 suggesting RBBB and there is a left axis deviation suggestingLAFB. In addition, the PR interval is prolonged and constant suggesting first degree heart block.

Right bundle branch block 21.jpg

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Shown below is an EKG with an rsR' pattern in lead V1, V2, andV3 suggesting RBBB. The EKG also shows a left axis deviation suggesting LAFB.

Right bundle branch block 22.jpg

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Shown below is an EKG with a slurred S wave in leads III, aVR, aVF,V1, and V2 suggesting RBBB. The EKG also shows a left axis deviation suggesting LAFB.

Right bundle branch block 23.jpg

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Shown below is an EKG depicting atrial fibrillation with a controlled ventricular rate. The QRS is wide (>120ms) and has a tall R' inV1 and an S wave in V6. There is a left axis deviation. The cardiogram suggests a right bundle branch block and a left anterior hemiblock. The patient has a cardiomyopathy with an ejection fraction of 20%.

Right bundle branch block 24.jpg

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Shown below is an EKG depicting sinus rhythm with a normal PR interval and a prolonged QRS interval (>120ms). There is a conduction abnormality best described as a right bundle branch block due to the rsR' wave in V1. Note the S wave in V6which is due to the RBBB is smaller than the R wave in V6. The axis of the QRS is difficult to determine, but one usually looks at the first 60 ms. (1 1/2 small squares) to determine the axis with a RBBB. If the axis of the first 60 ms. of the QRS is more than 90 degrees and there is an rS in lead I and a Q in lead III then one would consider a left posterior fascicular block. This is not the case here.

Right bundle branch block 25.jpg

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Sources

Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&offset=&limit=500.

References


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