Right bundle branch block

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Right bundle branch block

  1. 1. RIGHT BUNDLE BRANCH BLOCK Different presentations of RBBB in ECG illustrations DR. SHAZIA
  2. 2. Normal Ventricular Conduction  Normal Conduction   fibers of LBB begin conduction impulse travels across interventricular septum from left to right   travels across ventricles causing depolarization of both simultaneously   towards + electrode creates small r wave LV contributes most to complex impulse travels away from + electrode creates primarily negative complex
  3. 3. RBBB  RBBB in V1  no change in initial impulse travel    impulse depolarizes LV by itself since RBBB RV depolarized by impulse thru muscle   small r wave it now contributes to complex travels toward + electrode creating positive deflection
  4. 4. Right Bundle Branch Block Criteria    QRS duration ≥ 110ms rSR’ pattern or notched R wave in V 1 Wide and slurred S wave in I and V 6
  5. 5. R-R Pattern in RBBB and LBBB
  6. 6. DIFFERENCE BETWEEN RBBB AND LBBB
  7. 7. BBB Recognition    Use V1 Find Terminal force Identify direction of terminal force    Downward  LBBB Upward  RBBB Picture a Steering Wheel   Right turn  turn signal goes up Left turn  turn signal goes down
  8. 8. BBB Recognition  Terminal Force in V1  direction of deflection prior to J point J point
  9. 9. ECG ILLUSTERATIONS COMPLETE RBBB
  10. 10. INCOMPLETE RBBB; rSR pattern with normal QRS duration
  11. 11. INTERMITTANT RBBB WITH SINUS RHYTHM
  12. 12. RBBB and LAFB
  13. 13. IDENTIFY QUESTIONS ANS:COMPLETE RBBB
  14. 14. ANS: RBBB with left anterior fascicular block
  15. 15. ANS. INCOMPLETE RBBB
  16. 16. ANS: INTERMITTENT RBBB

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