Right bundle branch block electrocardiogram: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Right bundle branch block}} | {{Right bundle branch block}} | ||
{{CMG}}; {{AE}} {{CZ}} | |||
{{CMG}} {{AE}} {{CZ}} | |||
==Overview== | ==Overview== | ||
Criteria for complete [[right bundle branch block]] | Criteria for complete [[right bundle branch block]] include: a QRS duration of > .12 seconds, an rSR' pattern with a wide terminal R wave in V1 and a qRS complex with a wide S wave in V6. | ||
== | ==Electrocardiogram== | ||
===Diagnostic Criteria=== | |||
* The heart rhythm must be supraventricular in origin | * 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 axis can be either normal, or right or left axis deviation may be present. | ||
Line 13: | Line 13: | ||
** 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. | ** 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. | ***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., | * There should be a terminal R wave in lead V1-V3R (e.g., Rsr', 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. | ** 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. | * 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. | ** 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]]. | 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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Shown below is an electrocardiogram showing the main characteristics of right bundle branch block on lead V1. | |||
[[ | [[File:Right bundle branch block 3.png|center|300px]] | ||
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page | |||
---- | ---- | ||
Shown below is an example of an EKG showing sinus rhythm, [[wide QRS]] (>120ms.) and a markedly negative axis. There are small R waves in the inferior leads. The recording shows a right bundle branch block and a [[left anterior fascicular block]]. | |||
[[File:Right bundle branch block 2.jpg|center|500px]] | |||
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page | |||
---- | ---- | ||
;For EKG examples of right bundle branch block click [[Right bundle branch block EKG examples|here]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Electrophysiology]] | |||
[[Category:Disease]] | |||
[[Category:Cardiology]] | |||
[[Category:Emergency medicine]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} |
Latest revision as of 14:55, 12 April 2013
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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
Criteria for complete right bundle branch block include: a QRS duration of > .12 seconds, an rSR' pattern with a wide terminal R wave in V1 and a qRS complex with a wide S wave in V6.
Electrocardiogram
Diagnostic Criteria
- 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.
- 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.
- There should be a terminal R wave in lead V1-V3R (e.g., Rsr', 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.
Shown below is an electrocardiogram showing the main characteristics of right bundle branch block on lead V1.
![](/images/6/6b/Right_bundle_branch_block_3.png)
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
Shown below is an example of an EKG showing sinus rhythm, wide QRS (>120ms.) and a markedly negative axis. There are small R waves in the inferior leads. The recording shows a right bundle branch block and a left anterior fascicular block.
![](/images/0/0a/Right_bundle_branch_block_2.jpg)
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
- For EKG examples of right bundle branch block click here.