Right bundle-branch block - Clinicals, Diagnosis, and Management

Cardiovascular

Clinicals - History

Fact Explanation
Chest pain Patients with right bundle branch block (RBBB) can get myocardial ischemia/infarction in which the patient will present with chest pain
since the patients with RBBB and myocardial infarction often have significant coronary artery disease, they have a high mortality risk
Chest pain
Patients with right bundle branch block (RBBB) can get myocardial ischemia/infarction in which the patient will present with chest pain
since the patients with RBBB and myocardial infarction often have significant coronary artery disease, they have a high mortality risk
Gender-male Studies have shown that the prevalence of RBBB is higher in men than women Gender-male
Studies have shown that the prevalence of RBBB is higher in men than women
Old age Studies have shown that the prevalence of RBBB is high in old age Old age
Studies have shown that the prevalence of RBBB is high in old age
History of high blood pressure Studies have shown that the prevalence of RBBB is high in patients who have high systolic blood pressure History of high blood pressure
Studies have shown that the prevalence of RBBB is high in patients who have high systolic blood pressure
History of diabetes Studies have shown that the prevalence of RBBB increases with diabetes.The exact cause for this is not known History of diabetes
Studies have shown that the prevalence of RBBB increases with diabetes.The exact cause for this is not known
Patients with lung diseases/ chronic obstructive airway disease RBBB may be a result of any lung condition that causes a chronic elevation in the pressures of the right ventricle Patients with lung diseases/ chronic obstructive airway disease
RBBB may be a result of any lung condition that causes a chronic elevation in the pressures of the right ventricle
Palpitations Patients with RBBB can get arrhythmia which the patient feel as palpitations (less chance than the patients with left bundle branch block)
RBBB might be observed among idiopathic VF (ventricular fibrilation) patients and the prevalence of RBBB is higher in idiopathic VF patients than expected in the general population
Palpitations
Patients with RBBB can get arrhythmia which the patient feel as palpitations (less chance than the patients with left bundle branch block)
RBBB might be observed among idiopathic VF (ventricular fibrilation) patients and the prevalence of RBBB is higher in idiopathic VF patients than expected in the general population
Fainting attacks RBBB can give rise to heart blocks due to conduction abnormalities
It can also cause ventricular fibrilation leading to cardiac arrest
Fainting attacks
RBBB can give rise to heart blocks due to conduction abnormalities
It can also cause ventricular fibrilation leading to cardiac arrest
Ankle swelling,shortness of breath when lying down Patients with right ventricular cardiomyopathy and complete right bundle branch block very often have recurrent ventricular tachycardia and develop biventricular heart failure Ankle swelling,shortness of breath when lying down
Patients with right ventricular cardiomyopathy and complete right bundle branch block very often have recurrent ventricular tachycardia and develop biventricular heart failure
History of heart surgery Damaging to conductive system of the heart is a potential risk factor during heart surgery as the right bundle branch, courses within the muscle of the right ventricle, in a relatively superficial manner History of heart surgery
Damaging to conductive system of the heart is a potential risk factor during heart surgery as the right bundle branch, courses within the muscle of the right ventricle, in a relatively superficial manner
History of structural heart defects RBBB often occurs in any condition that affects the right ventricle eg: ventricular septal defects History of structural heart defects
RBBB often occurs in any condition that affects the right ventricle eg: ventricular septal defects

Clinicals - Examination

Fact Explanation
High blood pressure Studies have shown that the prevalence of RBBB is high in patients who have high systolic blood pressure.
Also patients can present with myocardial ischemia/infarction which can give rise to high blood pressure
High blood pressure
Studies have shown that the prevalence of RBBB is high in patients who have high systolic blood pressure.
Also patients can present with myocardial ischemia/infarction which can give rise to high blood pressure
Pulse- bradycardia or tachycardia Bradycardia due to heart blocks or tachycardia due to arrhythmia caused by defects in the conduction system of heart Pulse- bradycardia or tachycardia
Bradycardia due to heart blocks or tachycardia due to arrhythmia caused by defects in the conduction system of heart
Barrel shape chest RBBB may be a result of any lung condition that causes a chronic elevation in the pressures of the right ventricle Barrel shape chest
RBBB may be a result of any lung condition that causes a chronic elevation in the pressures of the right ventricle
Diabetic skin changes (loss of body hair,callosities etc) , diabetic retinopathic changes Studies have shown that the prevalence of RBBB increases with diabetes.The exact cause for this is not known Diabetic skin changes (loss of body hair,callosities etc) , diabetic retinopathic changes
Studies have shown that the prevalence of RBBB increases with diabetes.The exact cause for this is not known
Ankle oedema Congestive heart failure may occur in patients with RBBB due to ventricular dysfunction (less chance than in left bundle branch block) Ankle oedema
Congestive heart failure may occur in patients with RBBB due to ventricular dysfunction (less chance than in left bundle branch block)
Scar marks of previous heart surgery Damaging to conductive system of the heart is a potential risk factor during heart surgery as the right bundle branch, courses within the muscle of the right ventricle, in a relatively superficial manner Scar marks of previous heart surgery
Damaging to conductive system of the heart is a potential risk factor during heart surgery as the right bundle branch, courses within the muscle of the right ventricle, in a relatively superficial manner

Investigations - Diagnosis

Fact Explanation
Electrocardiogram Complete RBBB
1) QRS duration greater than or equal to 120 ms in adults, greater than 100 ms in children ages 4 to 16 years, and greater than 90 ms in children less than 4 years of age.
2) RSR in leads V1 or V2. The R deflection is usually wider than the initial R wave. In a minority of patients, a wide and often notched R wave pattern may be seen in lead V1 and/or V2.
3) S wave of greater duration than R wave or greater than 40 ms in leads I and V6 in adults.
4) Normal R peak time in leads V5 and V6 but greater than 50 ms in lead V1.
Of the above criteria, the first 3 should be present to make the diagnosis. When a pure dominant R wave with or without a notch is present in V1, criterion 4 should be satisfied
Electrocardiogram
Complete RBBB
1) QRS duration greater than or equal to 120 ms in adults, greater than 100 ms in children ages 4 to 16 years, and greater than 90 ms in children less than 4 years of age.
2) RSR in leads V1 or V2. The R deflection is usually wider than the initial R wave. In a minority of patients, a wide and often notched R wave pattern may be seen in lead V1 and/or V2.
3) S wave of greater duration than R wave or greater than 40 ms in leads I and V6 in adults.
4) Normal R peak time in leads V5 and V6 but greater than 50 ms in lead V1.
Of the above criteria, the first 3 should be present to make the diagnosis. When a pure dominant R wave with or without a notch is present in V1, criterion 4 should be satisfied

Investigations - Management

Fact Explanation
Echocardiogram As the patients with rigt bundle branch block can go into heart failure,echocardiogram is done to check the ejection fraction, left ventricular dysfunction Echocardiogram
As the patients with rigt bundle branch block can go into heart failure,echocardiogram is done to check the ejection fraction, left ventricular dysfunction
Electrocardiogram To detect arrhythmia and heart blocks Electrocardiogram
To detect arrhythmia and heart blocks
Lipid profile To control other co morbid conditions as patients with right bundle branch block have a high chance of mortality due to cardiovascular risk factors.
Recommended low-density lipoprotein cholesterol target level in people with heart disease <100 mg/dl
Lipid profile
To control other co morbid conditions as patients with right bundle branch block have a high chance of mortality due to cardiovascular risk factors.
Recommended low-density lipoprotein cholesterol target level in people with heart disease <100 mg/dl
Fasting blood sugar levels The prevalence of RBBB increases with diabetes
Also to control other co morbid conditions as patients with right bundle branch block have a high chance of mortality due to cardiovascular risk factors.Normal level <126mg/dl
Fasting blood sugar levels
The prevalence of RBBB increases with diabetes
Also to control other co morbid conditions as patients with right bundle branch block have a high chance of mortality due to cardiovascular risk factors.Normal level <126mg/dl
Fasting blood sugar The prevalence of RBBB increases with diabetes
Also to control other co morbid conditions as patients with right bundle branch block have a high chance of mortality due to cardiovascular risk factors.Normal level <126mg/dl
Fasting blood sugar
The prevalence of RBBB increases with diabetes
Also to control other co morbid conditions as patients with right bundle branch block have a high chance of mortality due to cardiovascular risk factors.Normal level <126mg/dl
Electrocardiogram Complete right bundle branch block (RBBB)
1) QRS duration greater than or equal to 120 ms in adults, greater than 100 ms in children ages 4 to 16 years, and greater than 90 ms in children less than 4 years of age.
2) RSR in leads V1 or V2. The R deflection is usually wider than the initial R wave. In a minority of patients, a wide and often notched R wave pattern may be seen in lead V1 and/or V2.
3) S wave of greater duration than R wave or greater than 40 ms in leads I and V6 in adults.
4) Normal R peak time in leads V5 and V6 but greater than 50 ms in lead V1.
Of the above criteria, the first 3 should be present to make the diagnosis. When a pure dominant R wave with or without a notch is present in V1, criterion 4 should be satisfied
Also to detect arrhythmia and heart blocks
Electrocardiogram
Complete right bundle branch block (RBBB)
1) QRS duration greater than or equal to 120 ms in adults, greater than 100 ms in children ages 4 to 16 years, and greater than 90 ms in children less than 4 years of age.
2) RSR in leads V1 or V2. The R deflection is usually wider than the initial R wave. In a minority of patients, a wide and often notched R wave pattern may be seen in lead V1 and/or V2.
3) S wave of greater duration than R wave or greater than 40 ms in leads I and V6 in adults.
4) Normal R peak time in leads V5 and V6 but greater than 50 ms in lead V1.
Of the above criteria, the first 3 should be present to make the diagnosis. When a pure dominant R wave with or without a notch is present in V1, criterion 4 should be satisfied
Also to detect arrhythmia and heart blocks
Echocardiogram Screen for structural heart lesions (eg:ventricular septal defects) as RBBB often occurs in any condition that affects the right ventricle.
Also, as the patients with right bundle branch block can go into heart failure,echocardiogram is done to check the ejection fraction, left ventricular dysfunction
Echocardiogram
Screen for structural heart lesions (eg:ventricular septal defects) as RBBB often occurs in any condition that affects the right ventricle.
Also, as the patients with right bundle branch block can go into heart failure,echocardiogram is done to check the ejection fraction, left ventricular dysfunction
Troponin I Elevated Troponin I levels due to myocardial infarction Troponin I
Elevated Troponin I levels due to myocardial infarction

Management - Supportive

Fact Explanation
Dietary modifications Since patients have high risk of cardiovascular mortality,diet control is necessary.Diet low in cholesterol Dietary modifications
Since patients have high risk of cardiovascular mortality,diet control is necessary.Diet low in cholesterol
Exercise Has shown to improve cardiovascular well being Exercise
Has shown to improve cardiovascular well being
Control of other co morbid conditions Control diabetes ,hypertension and cholesterol levels as the patients with right bundle branch block has a high mortality due to cardiovascular events Control of other co morbid conditions
Control diabetes ,hypertension and cholesterol levels as the patients with right bundle branch block has a high mortality due to cardiovascular events

Management - Specific

Fact Explanation
Percutaneous coronary intervension (PCI) Acute myocardial infarction with right bundle branch block (RBBB) is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI Percutaneous coronary intervension (PCI)
Acute myocardial infarction with right bundle branch block (RBBB) is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI
Pacemaker Required if a heart block is present Pacemaker
Required if a heart block is present
Surgical correction of structural heart lesions Correction of ventricular septal defects as RBBB often occurs in any condition that affects the right ventricle Surgical correction of structural heart lesions
Correction of ventricular septal defects as RBBB often occurs in any condition that affects the right ventricle

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