Right bundle branch block: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Bundle Branch Block.png|thumbnail]] | [[File:Bundle Branch Block.png|thumbnail]] | ||
*QRS | *QRS > 0.12 in limb leads | ||
*Triphasic QRS (rSR') or biphasic (qR), often with ST depression & TWI in V1-V3 | *Triphasic QRS (rSR') or biphasic (qR), often with ST depression & TWI in V1-V3 | ||
**V1 must have a positive complex | **V1 must have a positive complex | ||
**Second R wave in V1 is ''always'' taller than the first (rSR') | |||
*Slurred S in 1 and V6 | *Slurred S in 1 and V6 | ||
[[File:RBBB.jpg|thumb | *ST depression and TWI in other leads should arouse suspicion | ||
*'''Any ST elevation is abnormal in RBBB and must prompt evaluation for [[STEMI]]''' | |||
[[File:Rbbb morphology lead vi wm.jpg|thumbnail|RBBB V1 Morphologies]] | |||
[[File:RBBB.jpg|thumb|RBBB]] | |||
== | ==Differential Diagnosis== | ||
{{Tachycardia (wide) DDX}} | |||
==See Also== | ==See Also== | ||
| Line 16: | Line 19: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
*Journal of Electrocardiology. Vol 43 (2010). 40-42. | *Journal of Electrocardiology. Vol 43 (2010). 40-42. | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 06:36, 5 April 2019
Evaluation
- QRS > 0.12 in limb leads
- Triphasic QRS (rSR') or biphasic (qR), often with ST depression & TWI in V1-V3
- V1 must have a positive complex
- Second R wave in V1 is always taller than the first (rSR')
- Slurred S in 1 and V6
- ST depression and TWI in other leads should arouse suspicion
- Any ST elevation is abnormal in RBBB and must prompt evaluation for STEMI
Differential Diagnosis
Wide-complex tachycardia
Assume any wide-complex tachycardia is ventricular tachycardia until proven otherwise (it is safer to incorrectly assume a ventricular dysrhythmia than supraventricular tachycardia with abberancy)
- Regular
- Monomorphic ventricular tachycardia
- PSVT with aberrant conduction:
- PSVT with bundle branch block^
- PSVT with accessory pathway
- Atrial flutter with bundle branch block^
- Sinus tachycardia with bundle branch block^
- Accelerated idioventricular rhythm (consider if less than or ~120 bpm)
- Metabolic
- Irregular
- Atrial fibrillation/atrial flutter with variable AV conduction AND bundle branch block^
- Atrial fibrillation/atrial flutter with variable AV conduction AND accessory pathway (e.g. WPW)
- Atrial fibrillation + hyperkalemia
- Polymorphic ventricular tachycardia
^Fixed or rate-related
See Also
References
- Journal of Electrocardiology. Vol 43 (2010). 40-42.