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Wheeless' Textbook of Orthopaedics
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Right and Left Bundle Branch Block


-- QRS > 0.12 sec in Limb leads; -- Note: w/ LBBB, MI can't be accurately; dx'ed on EKG; (can't identify the Q waves) -- Note: the mean QRS Vector and Vent. Hypertrophy Can't be accurately calculated in the presence of B.B.B. -- May represent (pending) MI; ----------------------------------------------------------------------- Right B.B.B. (V1,2) Left B.B.B. (V5,6) Lft. V. /\ Rt. V. Rt.V. /\/\ Lft.V. /\ / \ / \ __/ \ / \__ / \ \ / __/ \__ \/ - RR in V1, V2 - RR in V5, V6, (I & aVL) - S wave in Lead I, V6, & aVL - Loss of normal Q's: I, aVL, V6 - may result from Ant MI - Complete LBBB lesion, Axis > - 45 - may occur w/ Ant Hemiblock - QS complex in V1, V2 - Loss of R in V1, V2; - Right bundle branch block can occur during passage of the Swan catheter through the right heart; - in a patient with preexisting left bundle branch block, this condition can lead to complete heart block. - in patient w/ left bundle branch block, transvenous pacing catheter should be be available;



Original Text by Clifford R. Wheeless, III, MD.