Bundle Branch Blocks and Chamber Enlargement

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Bundle Branch Blocksand Chamber Enlargement
All EKGs in this presentation have been borrowed
from The Alan E. Lindsay ECG Learning Center
http//medstat.med.utah.edu/kw/ecg/
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Outline

• Left Bundle Branch Block
• Right Bundle Branch Block
• Left Atrial Enlargement
• Right Atrial Enlargement
• Left Ventricular Enlargement
• Right Ventricular Enlargement
• Examples

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Left Bundle Branch BlockCriteria

• QRS duration 120ms
• Broad R wave in I and V6
• Prominent QS wave in V1
• Absence of q waves (including physiologic q
  waves) in I and V6

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Left Bundle Branch Block
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Right Bundle Branch BlockCriteria

• QRS duration 110ms
• rSR pattern or notched R wave in V1
• Wide S wave in I and V6

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Right Bundle Branch Block
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Conduction Blocks and Secondary Repolarization
Abnormalities
LBBB
RBBB
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Left Atrial Enlargement
Criteria P wave duration in II
120ms or Negative component of biphasic P wave
in V1 1 small box in area
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Right Atrial Enlargement
Criteria P wave height in II
2.4mm or Positive component of biphasic P wave
in V1 1 small box in area
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Left Ventricular Hypertrophy

• Many sets of criteria for diagnosing LVH have
  been proposed

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Romhilt-Estes Point System for LVH
4 points ? Probable LVH 5 points ? Definite LVH
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Left Ventricular Hypertrophy
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Right Ventricular Hypertrophy
Although there is no widely accepted criteria for
detecting the presence of RVH, any combination of
the following EKG features is suggestive of its
presence

• Right axis deviation
• Right atrial enlargement
• Downsloping ST depressions in V1-V3 (a.k.a. RV
  strain pattern)
• Tall R wave in V1

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Right Ventricular Hypertrophy
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Examples
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Left Ventricular Hypertrophy
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Right Bundle Branch Block
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Right Atrial Enlargement
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Left Bundle Branch Block
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Left Atrial Enlargement
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Right Ventricular Hypertrophy
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Left Ventricular Hypertrophy (with frequent PVCs)