Right Bundle Branch Block (RBBB) ECG Interpretation Explained, How to identify RBBB Block,USMLE NEET

okay in our video series of ECG interpretation Made Easy by six step method in this video we are going to talk about step 4 QRS assessment QRS assessment consists of R wave progression excess deviation and bundle branch block so in this video we are going to talk about bundle branch blocks in my previous video I have already discussed the r wave progression and excess deviation if you want to check out those videos the link of those videos is given in the description below now coming to bundle branch blocks remember essay node produces electrical currents in the heart and those electrical currents travel through the internodal pathways to the AV node and from AV node these electrical currents pass through bundle of hiss and from bundle office they divide into right bundle branch and left bundle branch now this left bundle branch has two further Parts it divides into posterior fascicle and anterior vesicle now whenever there is any block either in the right bundle branch block or in the left bundle branch block there is abnormality in the flow of current today we are going to talk about that now coming to right bundle branch block now remember when SA node produces electrical currents these electrical currents travel throughout the Atria and cause contraction of the air resulting in the P wave on ECG then these electrical currents travel to the AV node and from AV node they enter the ventricles to right and left bundle branches now whenever there is a block in the right side when the right bundle branch is blocked the currents will flow normally to the left side the currents will flow normally to the left side but there will be no current on the right side because there is a block so what will you will see on ECG is that there will be a first wave of QRS due to depolarization of the left ventricle then after some time the electrical currents from the left side will start traveling to the right side the electrical currents of the left side will start traveling to the right side to depolarize the right ventricle as well and that will appear as another QRS complex a combination of two QRS complex because both the ventricles are not Contracting simultaneously the left ventricle contracted earlier got depolarized earlier and you saw the first wave then the signals were transmitted from the left to right side and then the left ventricle got depolarized and you saw the second wave so that is called as an M wave that is also called as rabbit ears like the ear of the rabbit so that is a classical feature seen in bundle branch blocks now this m wave is seen in V1 in the right bundle branch block this is the first wave first wave due to left ventricle depolarization and this is the second wave due to the depolarization of the right ventricle and it is seen classically in V1 V2 the QRS morphology in V1 and V2 will be that there will be a first R wave and followed by a second R wave that appears as an M wave or rabbit ear that is called as rsr pattern in the lateral leads in V6 what you will see is that there will be slurring of the S Wave that there will be a deep S Wave that is called as a slurred S Wave in the lateral lead in V6 there is slurring of the S Wave a deep S Wave and in the V1 and V2 you will see M wave the rabbit ears now now the slurring of the S Wave this is the QRS wave this is the S Wave this S Wave can appear like this this can also appear like this this can also appear like this and this these are the different patterns in which slurring of the S Wave can be seen now in this ECG if you see in V1 you can see the two QRS complexes the M wave look at the two QRS complexes due to separate con depolarization of the left and right ventricle in V6 if you look this is the Deep S Wave that is the slurring of the S Wave that is seen in V6 now if you look at this ECG in this ECG if you look at V1 in V1 there are two QRS complexes they there is the m wave of the rabbit years if you zoom in you will see like this this is an M wave present in the V1 you can appreciate it even better in V2 and if you look at V3 there is also the M wave if you look at V5 and V6 you can see the slurring of the S Wave the Deep S Wave in V5 and V6 this is how the V6 is showing slurring of the SUV look at the pattern of S Wave this is the classical feature of right bundle branch block M wave in V1 V2 and slurring of the S Wave in V6 now if you look at this ECG in this ECG look at the V1 look at the M wave look at the M wave in V2 look at the M wave in V3 and look at the slurring of the S Wave in V5 V6 this is another ECG look at the V1 look at the M wave in V1 look at the M wave in V2 and V3 look at the S Wave in V6 this is another ECG with right bundle branch block look at the V1 look at the V1 look at the M wave look at the M wave in V2 look at the M wave in V3 in B5 V6 the slurring of the S Wave is absent but remember in between the slurring of S Wave and M wave in V1 M wave in V1 is more important than slurring of the S Wave if you see M wave in V1 V2 that is most likely due to right bundle branch block even if in the absence of slurring of S Wave in V6 now coming to the causes of right bundle branch block right bundle branch block occurs due to acute anteroceptal MI acute pulmonary embolism or infarction acute congestive heart failure acute myocarditis pericarditis hypertensive heart disease congenital heart condition anything that damages the right side of the heart can affect the bundle branches and can result in bundle branch block now we will solve some ECGs now look at this ECG what you should do is that you should pause the video and look at this ECG and find out your findings whether there is right bundle branch block present or not now we will solve the same ECG by a six step method in six step method first step is to look at the general impression what is your general impression the general impression is that the ECG looks it is not very fast it is not very slow and it is not showing any ugly morphologies so the general impression is good if you look at the calibration the second step is to look at the calibration if you look at the calibration the box of calibration is standard calibration because it is one large box wide and two large boxes tall that is a standard calibration it means that the ECG is being printed out at 25 millimeter per second now let's look at the Rhythm if you look at the Rhythm p waves are present and they are married to the QRS complexes p waves are followed by QRS complexes it means it is a sinus rhythm now let's calculate the rate in this ECG we will calculate the number of large boxes between the two RR intervals between these RR interval we have one two three four large boxes one large box is equal to 300 two large box 150 three large boxes 104 is almost 75 bits per minute so almost 75 to 80 beats per minute is the rate of this ECG now if you want to know about how to calculate rate Rhythm calibration general impression make sure to check out my playlists in my playlist I have talked about these things in detail I have discussed how do you look at the calibration what is general impression what is rhythm interpretation the link of those videos is given in the description below now let's look at the r wave progression as I said in my previous video that our wave progression is normal if in the hex axial lead except AVR all the QRS complexes should be positively deflected now AVR is negatively deflected which is normal the one lead one is positively deflected lead to positively deflected lead three is negatively reflected which is not normal it should be positively deflected lead AVL avf both are positively deflected so except lead 3 everything is normal but this is a poor R wave progression if you look at the precordial leads these precordial leads these should be negatively deflected V1 V2 should be negatively reflected V5 V6 should be positively deflected so over here V1 is positively deflected which is not normal so we will label it as poor R wave progression now we'll look at the axis if you look at the X's we will have to look on the Lead 1 and Lead avf if both of the leads are pointing upwards that's a normal F6 axis if they are pointing towards each other the QRS are pointing towards each other that is right Axis deviation if they are leaving each other that is the left axis deviation we have discussed all these things in our previous videos in one and two both are pointing upwards it's a normal axis Now look for the bundle branches if you look for the bundle branches we have M wave in V1 we have slurring of S Wave in V6 so this is a right bundle branch block so we have right bundle branch block so we will interpret this Rhythm as sinus rhythm at 75 bits per minute with poor R wave progression and right bundle branch block that is the six step method now we'll also discuss hypertrophism and ischemia the last two steps are still remaining and those will be discussed in the subsequent videos so this is the proper approach to discuss ECG this is the proper approach to in which you won't miss out any important finding in ECG now look at this ECG and then we will solve this ECG as well now what you should do is that you should pause the video try to solve this ECG yourself till the time you don't solve these ECGs you won't remember anything these things are very volatile now let's look at the general impression the general impression is that the ECG is not looking normal the ECG is not very fast not very slow and it is looking ugly it is the QRS complexes are wide so it looks wide now let's look at the calibration that calibration is two large boxes tall and one large box wide that is a standard calibration so it is a standard calibration let us look at the rate we have almost one thirty two three three large boxes between the RR intervals so three large boxes uh we have one large box so 300 to 153 so that is 100 100 beats per minute it is a sinus rhythm the p waves are present and they are followed by the QRS complexes although they are ugly they are wide but they are this is a sinus wave sinus rhythm because it is run by the SN or the p waves are present if the p waves are absent we could have said we could not have said with confidence that it is a sinus rhythm or not now let's look at the r wave progression in the r wave progression except AVR in the hex axial leads all pure s should be deflected positively upward one is positively reflected two is negatively deflected three is also negatively deflected AVL is positively reflected avf is also negatively reflected so this is a poor R wave progression in precordial leads in the precordial leads V one and V2 should be negatively deflected QRS complexes V1 V5 V6 should be positively reflected QRS complexes so they are positively reflected so that is not normal this is a poor R wave progression so R wave progression is poor and it is even absent there is no proper progression of the r wave let us look at the axis let us look at one and a v f they are leaving each other so if they leave the QRS leaves that is a left axis deviation if you uh let's look at the bundle branch blocks let's look at V1 now if you see in the V1 you will you will be thinking that we are not getting that classical M wave now sometimes the M wave can also present like this that it has a small the QRS complex has a small Notch present on it now that small Notch also indicates that it is a combination of two QRS complexes and this small Notch is actually showing that there are two QRS complexes so this is the small Notch present in the QRS complex and you can even find it better if you look at V2 and V3 in V2 you can see the two combination of two QRS complexes in V3 you can also treat the combination of two QRS complexes and V5 V6 we have the slurring of S Wave so it is a right bundle branch block now if you are getting confused by these things roof progression X is I have discussed everything in my previous videos you can check out those videos and learn everything about ECG so we will interpret this ECG as sinus rhythm at 100 bits per minute with poor R wave progression left excess deviation and right bundle branch block now now we are commenting on each and everything that is the beauty of six step method of determining ECG before going into the summary if you liked my video please click on the Subscribe button and make sure to check out my other videos on ECG interpretation we talked about what is bundle branch block how the QRS complex forms an M wave how the appearance of M wave in V1 and the appearance of slurring of S Wave in V6 V1 and V6 ECG is showing the right bundle branch block in some ECGs the M wave can be present in V1 and there might be absence of S Wave in V6 the causes of right bundle branch block and then at the end we solved the ECGs if you liked my video please click on the Subscribe button and make sure to check out my video on left bundle branch blog in the next video thank you very much

Channel: MedNerd - Dr. Waqas Fazal

Views: 55,169

Keywords: ECG, Ecg, ecg interpretation made easy, right bundle branch block, right bundle branch block ecg explained, right bundle branch block ecg treatment, rbbb, rbbb ecg, rbbb ecg explanation, ecg interpretation right bundle branch block, how to identify right, how to identify right bundle branch block on ecg, right bundle branch block usmle, ecg neet, reading of ecg graph, ecg learn

Id: o9m-bDayNg0

Length: 14min 44sec (884 seconds)

Published: Sat May 20 2023