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7 Cards in this Set
- Front
- Back
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ECG diagnosis of RBBB
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-A supraventricular rhythm
-QRS duration equal or greater than 120 ms (0.12 s) -Terminal R wave in lead V1 -S wave in lead I |
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Terminal wave
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-The last wave of a QRS complex is the terminal wave, or terminal deflection.
-If a QRS complex ends in an R wave, then it has a terminal R wave. -It can also be said that the terminal deflection is positive. |
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BBB depolarization
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-If the right bundle branch is blocked, the left ventricle depolarizes first
-the right ventricle depolarizes last? -lead I is the only precordial lead on the right side of the chest -A terminal R wave in lead V1 represents late right ventricular depolarization -The terminal S wave in lead I represents the same thing, because the positive electrode for lead I is on the left shoulder. -So, late left-to-right ventricular depolarization moves away from the positive electrode for lead I and toward the positive electrode for lead V1 |
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Abnormal RBBB (new RBBB)
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-Once you’ve identified a RBBB on the 12 lead ECG, the next thing you want to do is determine whether or not you’re dealing with a normal RBBB or an abnormal RBBB (or new RBBB).
-a new BBB” receives the most benefit in terms of lives saved per 1000 treated with fibrinolytics -the FTT Collaborative Group did not distinguish between LBBB and RBBB. -RBBB does not mimic or obscure the ECG diagnosis of acute STEMI the way LBBB does |
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Appropriate T wave discordance
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-use the concept of “appropriate T wave discordance” to see what’s “normal” for right bundle branch block
-For RBBB, the concept is that when the terminal deflection of the QRS complex is positive, the T wave should be negative. Likewise, when the terminal deflection is negative, the T wave should be positive. -This concept usually comes up in the context of discussing LBBB, but it’s also useful for RBBB |
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Benefits from reperfusion therapy
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-QRS confounders like right and left bundle branch block can make the ECG diagnosis of STEMI more difficult, but these are the patients who receive the most benefit from reperfusion therapy, and prompt, expertly performed primary PCI is the preferred strategy!
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12 lead view
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12 lead view
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