This ECG is from a 59-year-old man who was a patient in the Emergency Department with mild chest pain. He had a history of coronary artery disease. We have no other information about his medical history, medications, or outcome.
Bundle branch block
This ECG shows a “classic” left bundle branch block pattern.
The ECG criteria for left bundle branch block are:
This ECG shows a normal sinus rhythm at 73/min. and a right bundle branch block. The diagnostic characteristics of RBBB are: wide QRS (greater than .12 sec.), supraventricular rhythm (in this case NSR), and an rSR' pattern in V1 with a small, wide S wave in Leads I and V6. The R' and small s waves represent the right ventricle depolarizing slightly AFTER the left ventricle. In fact, in RBBB, each lead should look pretty normal at first, with a terminal right ventricular depolarization wave added to each QRS complex.
This ECG is from a healthy young man in his 20's. He was born with a ventricular septal defect (VSD) that was surgically repaired when he was a toddler. He now has a right bundle branch block, which could be a result of the defect, or the surgery. This is a good ECG for the Instructors' Collection because it clearly shows all the ECG characteristics of right bundle branch block: wide QRS in a supraventricular rhythm (in this case, NSR), rSR' pattern in V1, wide or "slurred" S waves in Leads I and V6. There is no rhythm strip below the 12 leads in this ECG, but
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