Right bundle branch block electrocardiogram: Difference between revisions

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== EKG Examples==
== EKG Examples==


<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:RBBB1.png|The main characteristics of [[Right Bundle Branch Block]] in V1
| [[Image:RBBB1.png|thumb|The main characteristics of [[Right Bundle Branch Block]] in V1]]
Image:ECG RBTB LAtrD.jpg|[[Right Bundle Branch Block]]
| [[Image:ECG RBTB LAtrD.jpg|thumb|[[Right Bundle Branch Block]]]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:RBBB.PNG|[[Right Bundle Branch Block]]
| [[Image:RBBB.PNG|thumb|[[Right Bundle Branch Block]]]]
Image:C13.ht13.jpg|[[Right Bundle Branch Block]]. 
| [[Image:C13.ht13.jpg|thumb|[[Right Bundle Branch Block]]]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:C14.ht14.jpg|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:C14.ht14.jpg|thumb|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
Image:C15.ht15.jpg|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:C15.ht15.jpg|thumb|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:C16.ht16.jpg|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:C16.ht16.jpg|thumb|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
Image:C17.ht17.jpg|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:C17.ht17.jpg|thumb|[[Right Bundle Branch Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:C18.ht18.jpg|[[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>
| [[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>]]
Image:C22.ht22.jpg|[[Right Bundle Branch Block]] with RA hypertrophy. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[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>]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:RBBB_inf_MI.jpg|Patient with [[RBBB]] and [[Acute MI|inferior MI]]. Note to left axis deviation.
| [[Image:RBBB_inf_MI.jpg|thumb|Patient with [[RBBB]] and [[Acute MI|inferior MI]]. Note to left axis deviation.]]
Image:RBBB_inf_MI_V4R.jpg|The same patient. Lead V4R. ST elevation shown.
| [[Image:RBBB_inf_MI_V4R.jpg|thumb|The same patient. Lead V4R. ST elevation shown.]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:RBBB_inf_MI_baseline.jpg|The same patient before [[acute MI]] developed. Horizontal axis shown.
| [[Image:RBBB_inf_MI_baseline.jpg|thumb|The same patient before [[acute MI]] developed. Horizontal axis shown.]]
Image:R11.ht36.jpg|[[Supraventricular tachycardia]] with [[RBBB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:R11.ht36.jpg|thumb|[[Supraventricular tachycardia]] with [[RBBB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:cominf12.jpg|Old [[Acute MI|Anterior MI]] with [[RBBB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[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>]]
Image:cominf19.jpg|Old [[Acute MI|Inferior MI]] and [[Acute MI|Anterior MI] with [[RBBB]] and [[LAFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:cominf19.jpg|thumb|Old [[Acute MI|Inferior MI]] and [[Acute MI|Anterior MI]] with [[RBBB]] and [[LAFB]].]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:cominf5.jpg|Old [[Acute MI|Inferior MI]] and [[RBBB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[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>]]
Image:c3.htm3.jpg|[[RBBB]] + [[LAFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:c3.htm3.jpg|thumb|[[RBBB]] + [[LAFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
</gallery>
|}
</div>




<div align="left">
{| align="center"
<gallery heights="175" widths="175">
|-valign="top"
Image:c19.ht19.jpg|[[RBBB]] + [[LAFB]] + [[First Degree AV Block]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[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>]]
Image:c20.ht20.jpg|[[RBBB]] + [[LAFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
| [[Image:c20.ht20.jpg|thumb|[[RBBB]] + [[LAFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
</gallery>
| [[Image:c21.ht21.jpg|thumb|[[RBBB]] + [[LPFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>]]
</div>
|}
 
 
<div align="left">
<gallery heights="175" widths="175">
Image:c21.ht21.jpg|[[RBBB]] + [[LPFB]]. <small>  [http://www.ganseman.com/ecgbibnl.htm#_top000 Image courtesy of Dr Jose Ganseman]</small>
</gallery>
</div>


==References==
==References==

Revision as of 15:04, 24 August 2012

Right bundle branch block Microchapters

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Overview

Historical Perspective

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Differentiating Right bundle branch block from other Diseases

Epidemiology and Demographics

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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]

Overview

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.

EKG Examples

The main characteristics of Right Bundle Branch Block in V1
File:ECG RBTB LAtrD.jpg
Right Bundle Branch Block


Right Bundle Branch Block
Right Bundle Branch Block


Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman
Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman


Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman
Right Bundle Branch Block. Image courtesy of Dr Jose Ganseman


Right Bundle Branch Block with first degree AV block. Image courtesy of Dr Jose Ganseman
Right Bundle Branch Block with RA hypertrophy. Image courtesy of Dr Jose Ganseman


Patient with RBBB and inferior MI. Note to left axis deviation.
The same patient. Lead V4R. ST elevation shown.


The same patient before acute MI developed. Horizontal axis shown.
Supraventricular tachycardia with RBBB. Image courtesy of Dr Jose Ganseman


Old Anterior MI with RBBB. Image courtesy of Dr Jose Ganseman
Old Inferior MI and Anterior MI with RBBB and LAFB.


Old Inferior MI and RBBB. Image courtesy of Dr Jose Ganseman
RBBB + LAFB. Image courtesy of Dr Jose Ganseman


RBBB + LAFB + First Degree AV Block. Image courtesy of Dr Jose Ganseman
RBBB + LAFB. Image courtesy of Dr Jose Ganseman
RBBB + LPFB. Image courtesy of Dr Jose Ganseman

References

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