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 is because the left ventricle depolalrizes normally. In this patient, R waves progress fairly soon in the precordial leads (V1 through V2). It is not known in this case if it is due to poor electrode placement or patient causes.
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ECG Diagnosis of RBBB
Good teaching example of RBBB posted by Dawn this week. I'd make the following teaching points regarding this tracing and ECG diagnosis of RBBB in general:
Ken Grauer, MD www.kg-ekgpress.com [email protected]