Right Bundle Branch Block: The Daily PANCE Blueprint

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Right Bundle Branch Block: The Daily PANCE Blueprint

A 62-year-old male gets an EKG done in the ER. It reveals a QRS duration of 132 ms, an RSR' pattern in lead V1, and a broad, slurred S wave in lead I. He denies chest pain, shortness of breath, or syncope. Which of the following is the most likely diagnosis?

A. Left bundle branch block
B. Ventricular tachycardia
C. Right bundle branch block
D. Anterior myocardial infarction
E. Wolff-Parkinson-White syndrome

Answer and topic summary

The answer is C. Right bundle branch block

Right bundle branch block results when the His-Purkinje system’s electrical activity is interrupted. Etiologies of an RBBB include structural heart disease, pulmonary embolism, myocardial ischemia or inflammation, increased RV pressures, congenital heart disease, and iatrogenic (e.g., from right heart catheter insertion). EKG will show a wide QRS complex (>120 ms), RSR’ pattern in leads V1 or V2 (also possible to see Rsr’, rsR’, or rSR’), and a slurred, wide S wave in lateral leads (I, aVL, V5-V6). People with RBBs typically do not need treatment.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Conduction Disorders (PEARLS) ⇒ Bundle branch block

Also covered as part of the Emergency Medicine PAEA EOR topic list

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