1. QRS > 120 msec (100 - 119 = incomplete)2. rSR' in right precordial leads
3. Wide S wave in I, V5, V6
4. +/- ST depression or T wave inversion in right precordial leads
3. Wide S wave in I, V5, V6
4. +/- ST depression or T wave inversion in right precordial leads
Funny looking right bundle branch block patterns to beware of:
Arrhythmogenic Right Ventricular Cardiomyopathy
Brugada Syndrome
Source
Wylie, J. Pinto, D. Josephson, M. "Brugada syndrome and sudden cardiac arrest" Up to Date. 12 Feb 2009.
Mckenna, W. "Clinical manifestations and diagnosis of arrhythmogenic right ventricular cardiomyopathy." Up to Date. 24 Jan 2009.
Arrhythmogenic Right Ventricular Cardiomyopathy- An important cause of sudden cardiac death in young adults, particularly those of Italian heritage, caused by a fibrofatty replacement of the right ventricular myocardium
- EKG characteristics: QRS frequently prolonged (consistent with delayed right ventricular activiation), may be a pattern of incomplete or complete RBBB, thirty percent have epsilon wave (a distinct wave just beyond the QRS complex, particularly in V1) which represents delayed activation of some portion of the right ventricle
Brugada Syndrome- A cause of sudden cardiac death secondary to sodium channelopathy
- EKG characteristics: pseudo-RBBB and persistent ST segment elevation in leads V1 - V3 (there are three subtypes of this, type I is shown above)
Source
Wylie, J. Pinto, D. Josephson, M. "Brugada syndrome and sudden cardiac arrest" Up to Date. 12 Feb 2009.
Mckenna, W. "Clinical manifestations and diagnosis of arrhythmogenic right ventricular cardiomyopathy." Up to Date. 24 Jan 2009.