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right bundle branch block ,rbbb,right heart failure
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- 2. RBBB • Types ofRBBB • ECG Diagnostic Criteria Causes • Electrophysiology • Causes • Examples
- 3. TYPES OF RBBB •COMPLETE RBBB • INCOMPLETE RBBB
- 4. ECG DIAGNOSTIC CRITERIA •QRS duration > 120ms • RSR’ pattern in V1-3 (“M-shaped” QRS complex) • Wide, slurred S wave in lateral leads (I, aVL, V5-6)
- 5. ELECTROPHYSIOLOGY • In normalcardiac conduction, impulses travel equally down the left and right bundles, with the septum activated from left to right ,followed by para septal activation followed by free wall activation seperately. • In RBBB, the left ventricle is activated normally, thus the early part of the QRS complex correlating to septal depolarisation is unchanged
- 6. ELECTROPHYSIOLOGY • There isdelayed activation of the right ventricle as depolarisation originates from the left ventricle across the septum. This produces a secondary R wave (R’) in the precordial leads, and a wide, slurred S wave in lateral leads
- 7. SEQUENCE OF CONDUCTIONIN RBBB: • Septal depolarisationis thus unaffected, producing a normal early QRS complex • Left ventricular activation via the left bundle occurs normally • Activation of the RV originates across the septum from LV musculature
- 8. MECHANISM OF RSRPATTERN IN RT CHEST LEADS • There is an initial small r wave due to left septal depolarisation • This is followed by an S, or more likely a s, wave which is due mainly to depolarisation of the left free wall , S wave is attenuated and may even disappear completely. • There is a terminal bizarre and slurred R wave (R') due to late and anomalous right septal and right free wall depolarisation
- 10. • There isa small initial q wave, due to left septal depolarization • There is a relatively tall R wave, due mainly to depolarization of the left free wall • There is a terminal bizarre and slurred S wave due to late and anomalous right septal and right free wall activation MECHANISM OF SLURRED SWAVE IN LT CHEST LEADS
- 11. THE ST SEGMENTAND T WAVE IN RIGHT BUNDLE BRANCH BLOCK • uncomplicated RBBB, the T wave and ST segment will reflect secondary changes. • The T wave is opposite in direction to the terminal QRS deflection. • Thus, if the terminal deflection is an R', as occurs, for example, in lead V1, the T wave will be inverted • The associated ST segment will be slightly convex-upwards and, at times, minimally depressed.
- 13. • The terminaldeflection is an S wave, as occurs, for example, in lead V6, the T wave will be upright • The associated ST segment will be slightly concave-upwards, and, at times, minimally elevated. • Any deviation from these manifestations usually represents a primary change that is a primary myocardial abnormality in addition to the RBBB. THE ST SEGMENT AND T WAVE IN RIGHT BUNDLE BRANCH BLOCK
- 14. INCOMPLETE RBBB • There’sa diminition S wave in lead v2. • A small R’ deflection will appear as the as the delay increases due to block. • The R’ deflection becomes increasingly taller as the delay increases since larger part of Rt free wall activation occurs after Lt free wall activation. • While the ORS complex reflects a slight increase in duration, it is not increased beyond 110 ms. The R' deflection itself is not widened beyond 40 ms.
- 16. THE SIGNIFICANCE OFTHE ANATOMICAL LENGTH OF THE RIGHT BUNDLE BRANCH • slowed conduction is not the only cause of conduction delay in the genesis of incomplete RBBB. The length of the right bundle branch may also play a significant role • The anatomical factor is clearly significant when there’s dilatation of the Rt ventricle d/t • Atrial septal defect • Chronic corpulmonale • Tricupsid insufficiency
- 17. CAUSES • RV strain(COPD,cor pulmonale, PTE, PH, PS) • Degenerative disease of conductive system • Cardiomyopathies • Myocarditis • Ischemic heart disease • Congenital heart diseases(suchas ASD)
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