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Right Bundle Branch Block - Articles

Left ventricular Aneurysm Morphology Distorted by Right Bundle Branch Block, Mimicking Acute STEMI with RBBB by Stephen Smith Posted Wed 25 Jan 2012 9:41am This is a complex case that I have reprinted from my article in the EMRA publication, EM Resident , with their permission.  I'm starting with some didactics.  If you want skip to the case, page down, but it is difficult to understand without knowing the background information. GENERAL BACKGROUND Prior Myocardial Infa ... Read on »
Right Bundle Branch Block (RBBB) with Anterolateral STEMI by Stephen Smith Posted Tue 12 Jan 2010 12:54pm A 62 yo male with h/o CAD and stent in 1st OM presented with Chest pain while biking. Vitals were normal. An ECG was recorded: There is Right Bundle Branch Block with large R-wave in V1 (the first R wave of the rsR' is not present) and wide S-wave in lateral leads I, aVL, V5 and V6. There is a slight amount of ST elevation (1 mm) in lead V3 ... Read on »
Right Bundle Branch Block with Subtle ST Elevation: LAD 95% occluded by Stephen Smith Posted Thu 28 Jan 2010 12:49pm An 81 yo woman presented at 2 AM to the ED with severe substernal chest pressure. This ECG was recorded There is sinus rhythm with a PVC, and Right Bundle Branch Block (RBBB). Normally there is no ST elevation with RBBB. In fact, normally, there are inverted T waves (discordant to a positive QRS due to the large R' wave, of the rSR') and fro ... Read on »
How do you locate the level of the lesion in Right bundle branch block ? by Dr. Sangareddi V. Medical Doctor Posted Sat 24 Apr 2010 11:41pm Like in neurological disease, one can locate the site of block in bundle branch blocks. Though it has never been thought ,  to be clinically important to localise a BBB . (Unlike coronary lesions) Generally ,  RBBB can be proximal  or  distal peripheral type.The commonest site could be the distal  type. It should be realised , for over ... Read on »
Right Bundle Branch Block with Biphasic Wave in lead V2? by Stephen Smith Posted Fri 16 Aug 2013 8:57am A middle-age alcoholic presents with weakness and vague abdomimal discomfort.  The patient's previous ECG was from 4 years prior and was completely normal.  Here is the presenting ECG There is sinus rhythm and Right Bundle Branch block.  There is a tall R-wave in V2 and V3 and slightly excessive ST depression in lead V2, with a bip ... Read on »
Right Bundle Branch Block with New Anterior ST elevation by Stephen Smith Posted Fri 04 Jan 2013 2:32pm An elderly female with no known history of CAD presented to the ED as a walk-in with vomiting and upper abdominal discomfort.  The following ECG was recorded at t = 0 There is sinus rhythm with Right Bundle Branch Block and ST elevation in leads V1 and V2, suspicious for STEMI. The computerized QRS duration is 138 ms.   A previ ... Read on »
Right Bundle Branch Block after Blunt Trauma: A Tragic Case. by Stephen Smith Posted Sun 22 Jul 2012 5:33pm A 6 yo girl had significant trauma from  an MVC, with head injury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries.  She was intubated.  A FAST exam was normal (no pericardial or peritoneal fluid).  As part of her workup, this ECG was recorded There is sinus tachycardia, with right bundle branch block ( ... Read on »
Right Bundle Branch Block with ST elevation in V2, V3. Why? by Stephen Smith Posted Sun 15 Sep 2013 5:06pm This young male patient had a very atypical presentation for STEMI (near syncope and abdominal pain after smoking an unknown drug), but we can pretend that it was not atypical and think about how we would interpret the ECG There is right bundle branch block with an rSR' in V1 and wide S-wave in lateral leads.  The ST segment is ele ... Read on »
Posterior ST Elevation MI in the Setting of Right Bundle Branch Block, with Posterior Leads V7-V9 by Stephen Smith Posted Sat 05 Dec 2009 10:57am 1 Comment This is a 68 year old man who had a resuscitated cardiac arrest. His prehospital ECG looks identical to this one which was recorded upon arrival to the ED There is sinus rhythm with a wide QRS, with rSR' in V1 and a wide S-wave in lateral leads, consistent with right bundle branch block (RBBB). ST elevation or depression in RBBB is not diff ... Read on »
Chest Pain and Right Bundle Branch Block. What is the Diagnosis? by Stephen Smith Posted Fri 16 Nov 2012 11:40am A male in his 70's with no h/o MI or CAD presented with new onset chest pain.  Here is his ED ECG There is sinus rhythm and right bundle branch block, and ST elevation in V1-V3.  Normally, RBBB has ST depression in right precordial leads, especially V2 and V3 (see ECG below).  Sometimes it is isoelectric.  But if there is ... Read on »