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Cases | Cardiothoracic | Todd Hunter
Following the examination Dr. Grey obtained an EKG:
What does Todd's EKG show?
a. Recent transmural myocardial infarction b. Left bundle branch block with right axis deviation c. Right bundle branch block with left axis deviation d. Idioventricular rhythm
The correct answer is c. Right bundle branch block is characterized by the wide QRS complex measuring at least .12 seconds in width, S waves in leads 1 and V6, and the typical RSR' or "rabbit ears" configuration in the septal leads, V1-3. The net negative voltage in leads 2 and F define left axis deviation. The combination of the RBBB and left axis is also referred to as "bifascular block." Recent transmural myocardial infarction would be evidenced by pathological Q waves. Idioventricular rhythm is characterized by a wide QRS complex and may resemble bundle branch block. However, there would be no p waves. What are the causes and mechanism of right bundle branch block? Of bifascular block?
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