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What should be done when suffering form RBBB?

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Cardiologist
Practicing since : 1998
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With the RBBB pattern existing in v1 (m shaped) : should the qrs be more than 3 squares (120 ms) on all leads or just v1 for it to qualify as RBBB ??? I am having conflicting opinions from doctors weather the attached ecg is complete or incomplete ??
Posted Fri, 14 Mar 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Sukhvinder Singh 22 minutes later
Brief Answer: Complete RBBB Detailed Answer: Dear Sir 1. The attached ECG shows "Complete Right bundle branch block" beyond doubts. The PR interval is normal. There is no left hemiblock. There is possibly left atrial abnormality (if clinically correlating). 2. It shows QRS duration more than 120 ms (3 squares) in multiple leads. However, that is not the issue; because QRS duration is taken from the lead where it is maximum. 3. RBBB can be totally benign entity or it may be associated with underlying heart disease. In case of any suspicion, we advise ECHO or cardiac ultrasound to sort out the issue. Hope this helps. Feel free to discuss further. Sincerely Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: What should be done when suffering form RBBB? 11 minutes later
Thank you for your answer. Echo was done twice and got a notmal result. Does this rule out left atrial abnormality ? If rbbb is benign is it compatible with s
 
 
Answered by Dr. Sukhvinder Singh 41 minutes later
Brief Answer: please see details. Detailed Answer: Dear Sir 1. Your question's second part is not clear. is it compatible with s....... 2. Yes, a normal ECHO rules out left atrial abnormality. Sincerely Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: What should be done when suffering form RBBB? 5 minutes later
My second question is that can i still be exercising for a tennis tournament , ever since i discovered my rbbb five years ago i am always worried when i exercise although i never experience any symptoms? Which other primary leads show a qrs more than 120? I printed out today my ecg and measured it with a ruler and it seems that it is almost exactly 120 or very little over . Is that true ? Which other primary leads show qrs more than 3 little squares ? What is the pattern in v1 is it rSr' ? Thanks
 
 
Answered by Dr. Sukhvinder Singh 9 minutes later
Brief Answer: please see details Detailed Answer: Dear Sir 1. Yes, since you are asymptomatic and your ECHO is also normal. There is no contraindication to exercise as far as this RBBB goes. 2. Yes, pattern in V1 is rSr'. There is one small positive wave called "r" followed by larger negative wave called "S" which is followed by another small positive wave called " r' ". 3. Lead I, Lead II have complexes where QRS duration is more than 120 ms and V2-V6 (5 leads) show it to be at least 120 ms. Sincerely Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: What should be done when suffering form RBBB? 2 minutes later
Do you think this is benign even with 5 leads showing prolonged qrs?
 
 
Answered by Dr. Sukhvinder Singh 5 minutes later
Brief Answer: please see below Detailed Answer: Dear Sir 1. QRS duration, whatsoever it is, will be nearly same in all leads. Because we are looking at same thing from different angles. Because of vector's position the duration is different by few milliseconds in different leads. Hence implications of prolonged QRS will not change with this minor difference. In nutshell, the RBBB will remain benign even if all leads show QRS prolongation because this criteria do not determine the effects or implications of RBBB. sincerely Sukhvinder
Above answer was peer-reviewed by
 
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