24 bb bs

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24 bb bs

  1. 1. 12-Lead Electrocardiography a comprehensive course Adam Thompson, EMT-P, A.S.
  2. 2. Bundle Branches
  3. 3. Bundle Branch Blocks• Right Bundle Branch Block (RBBB) – The single right fascicle is blocked.• Left Bundle Branch Block (LBBB) – Both left fascicles are blocked.• Non-Specific Intraventricular conduction delay (IVCD) – BBB that doesn’t meet RBBB or LBBB criteria.
  4. 4. Bundle Branch Blocks• May mimic an MI• The side that is blocked conducts last and takes longer.
  5. 5. Bundle Branch Blocks Mean vector• Normal conduction 4 Cardiac vector without a block. 1 3 3 2 2
  6. 6. Bundle Branch Blocks • With a RBBB, the right fascicle is blocked, so the left ventricle is1 conducted first and 2 then the impulse 3 returns to the right.
  7. 7. Bundle Branch Blocks • With a LBBB, the right ventricle is conducted first, and the impulse1 travels back to the 2 left. 3
  8. 8. Bundle Branch BlocksV1
  9. 9. Bundle Branch Blocks V1 J-PointsThe J-point is the exact point where the QRS ends
  10. 10. Bundle Branch BlocksV1
  11. 11. Bundle Branch BlocksV1
  12. 12. Bundle Branch BlocksV1
  13. 13. Bundle Branch BlocksV1 = RBBBV1 = LBBB
  14. 14. Bundle Branch BlocksV1 LBBB RBBB
  15. 15. Right Bundle Branch Block • RBBB morphologiesV1
  16. 16. Right Bundle Branch Block• To properly differentiate between bundle branch blocks, you must also assess leads I and V6.• A slurred S-wave in leads I and V6 indicate a RBBB.
  17. 17. Right Bundle Branch Block I & V6
  18. 18. Right Bundle Branch BlockI V1 aVR V4 II aVL V2 V5 V6 III aVF V3
  19. 19. Right Bundle Branch Block Slurred S-Wave I & V6
  20. 20. Right Bundle Branch Block + + A B A + BMean vector moves towards positive electrode = positive QRSMean vector moves away from positive electrode = negative QRSMean vector is perpendicular to positive electrode = equiphasic QRS
  21. 21. Right Bundle Branch Block 1 2 + I & V6 3
  22. 22. Right Bundle Branch Block
  23. 23. Right Bundle Branch Block
  24. 24. Right Bundle Branch Block
  25. 25. Right Bundle Branch Block
  26. 26. Right Bundle Branch Block
  27. 27. Left Bundle Branch Block• Duration greater than 0.12 sec• Broad monomorphic R-wave in I & V6• Terminal S-wave in V1.
  28. 28. Left Bundle Branch Block V1
  29. 29. Left Bundle Branch BlockII V1 aVR V4 II aVL V2 V5 V6 III aVF V3
  30. 30. Left Bundle Branch Block
  31. 31. Left Bundle Branch Block
  32. 32. Left Bundle Branch Block
  33. 33. Left Bundle Branch Block
  34. 34. Intraventricular Conduction Delay• A Non-specific IVCD is less common than a RBBB or LBBB• They are wide, atrial rhythms that usually look like a left or right BBB in V1, but do not match the criteria in I & V6.
  35. 35. Non-Specific IVCDI I V1 aVR V4 II aVL V2 V5 V6 III aVF V3
  36. 36. Non-Specific IVCD
  37. 37. Non-Specific IVCD
  38. 38. BBB Chart RBBB LBBB IVCD TERMINAL TERMINAL TERMINAL V1 R-WAVE S-WAVE R/S-WAVE TERMINAL TERMINAL Anything isI & V6 possible S-WAVE R-WAVE

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