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'Right Branch Bundle Block'
My 15 yr old son collapsed in the bathroom while standing in front of the sink the other night. This has never happened before, although he did complain of dizziness a couple of days earlier. He takes Dexedrine, but has done so for many years and never experienced anything like this. Just to note, I noticed afterwards that his pupils were not the same size. I took him to Dr. who did an ECG and a hematology panel of blood tests. He told me there was a Right Bundle Branch Block or incident on the ECG and he would confer with a cardiac specialist and get back to me. Is this an appropriate way to handle this? My son is supposed to travel next week with his school out of province and I'm concerned about that and also don't quite know what to make of this. Can this be serious? Is RBBB a congenital condition, or are there causations, like medications, or, over exertion? What are the treatments, if any? Thank-You.
An improper dosage of Dexedrine can cause dilation of pupils and cause dizziness. And an EKG can give a false positive when taking medication and/or if there is an elctrolyte imbalance. The "incident" referred to by the doctormay be an artefact (produced by chemical or other artificial means.
The RBBB indicates some blockage of the electrical action in the conducting system. This may be due to ischemia, necrosis of the conducting tissue, electrolyte abnormality, or hypothermia (lower than normal body temperature), etc..
The RBBB indicates some blockage of the electrical action in the conducting system. This may be due to ischemia, necrosis of the conducting tissue, electrolyte abnormality, or hypothermia (lower than normal body temperature), etc..
My little 4 year old has a RBBB(according to his cardiologist it is a complete one)they haven't treated him for it. it does show up on an EKG. this won't show up on an echo since it is your electrical part of your heart.I would say if he continues to have problems to not let him go with the school and try to get him in sooner to the cardiologist to make sure everything is okay. if he doesn't seem to have anymore issues then I would let him go. please trust me when I say I can totally understnd how you feel right about now. no one in my family has a RBBB or for that matter any heart issues. I jhave not noticed when Chris passed out the one time (not sure what caused it his little heart rate went from a great rate of 110 down to 48 and then up to 181), that his pupils weren't ueven.
I have googled some information on RBBB hope this helps. usually the right one is not of any danger it is the left one that is of concern. I copied and pasted this information I didn't paste the information on the left BBB
good luck and I hope all goes well
michelle
Right bundle branch block (RBBB)
In RBBB, the right bundle branch no longer conducts electricity. Therefore, as the electrical impulse leaves the His bundle, it enters left bundle branch only, and is carried to the left ventricle. Then, from the left ventricle, the electrical impulse finally makes its way to the right ventricle. As a result, the two ventricles no longer receive the electrical impulse simultaneously. First the left ventricle receives the electrical impulse, then the right.
Why does the QRS complex change in BBB? The QRS represents the spread of the heart’s electrical impulse across the right and left ventricles. Because with BBB the ventricles receive the electrical impulse one after another instead of at the same time, it takes longer to form the QRS complex on the ECG. The QRS complex is said to “widen.” Also, since the pattern of the spreading of the electrical impulse is abnormal in BBB, the pattern of the QRS complex is also abnormal.
What is the significance of bundle branch block?
BBB is quite common, and occurs in a variety of medical conditions. RBBB occurs in medical conditions that affect the right side of the heart or the lungs, so a finding of RBBB on the ECG ought to trigger a screening exam for such conditions. These include blood clots to the lung (pulmonary embolus), chronic lung disease, cardiomyopathy, and atrial and ventricular septal defects. However, RBBB also commonly occurs in normal, healthy individuals, and the screening exam therefore often turns up no medical problems. In these cases, the RBBB has no apparent medical significance, and can be written off as a “normal variant,” and safely ignored.
ometimes either the right or the left bundle branch conducts the electrical impulse more slowly than normal, but is not completely blocked. When this occurs, on the side of the slow conduction, the electrical impulse arrives in the ventricle slightly later than normal. As a result, the QRS complex is slightly wider than normal, but not as wide as it would be with a complete BBB. This slight widening of the QRS is often called incomplete BBB. (Another name for it is an “intraventricular conduction defect," or an IVCD.)
Incomplete bundle branch block sometimes indicates underlying heart disease. But, especially when it occurs on the right side (i.e., incomplete RBBB,) it often has no significance at all. So in general, incomplete bundle branch block should trigger a non-invasive search for underlying heart disease. If none is found, no further tests or treatment are needed.
The Hemiblocks
The left bundle branch itself divides into two major branches – the anterior and the posterior fascicles. Sometimes block can occur in just one of these fascicles. Such blockage is referred to as a hemiblock, or a fascicular block. (Note that the right bundle branch does not divide into discrete fascicles.)
When blockage is in the anterior fascicle, left anterior hemiblock (or left anterior fascicular block) is said to be present; whereas if the blockage occurs in the posterior fascicle, then left posterior hemiblock (or left posterior fascicular block) is said to be present.
Hemiblock generally does not widen the QRS complex, but instead changes the pattern of the QRS complex. (It alters the “axis” of the QRS complex. The axis is calculated by measuring the pattern of the QRS complex on several of the 12 leads acquired on a standard ECG.)
In general, finding a hemiblock should trigger a search for underlying heart disease. Often none is found, in which case the hemiblock can be ignored.
Treating BBB
As we have noted, the heart depends on the bundle branches. Without them, the electrical impulse is not delivered to the ventricles. Block in both bundle branches, therefore (a condition called complete heart block,) can be fatal.
Fortunately, it is quite uncommon for stable RBBB or LBBB to progress to complete heart block. Thus, despite the fact that BBB is a common finding on routine ECGs, it is an uncommon reason for implanting pacemakers.
Still, there are a few conditions in which people with bundle branch block require pacemakers:
1) When “conduction system disease” is bilateral, and is associated with a heart attack:We have previously noted that RBBB plus left anterior hemiblock should not be particularly alarming. This is true except in this one instance – where the block occurs acutely with a heart attack. Here, the conduction system disease tends to be unstable, and can progress to complete heart block. These patients often need pacemakers.
2) When bundle branch block is associated with syncope (loss of consciousness):When a patient with bundle branch block experiences syncope, in general an electrophysiology study should be considered to test for impending complete heart block. A permanent pacemaker eliminates the problem.
3) In certain patients with dilated cardiomyopathy:In patients who have dilated cardiomyopathy and either complete or incomplete bundle branch block, a new form of pacing – called cardiac resynchronization pacing or CRT – has now been shown to improve symptoms and to prolong life. CRT should now be strongly considered in any patient with heart failure and bundle branch block. Click here to read more about CRT.
As we have seen, bundle branch block causes the ventricles to beat sequentially (one after another) instead of simultaneously. This discoordination of the normal pattern of ventricular contraction diminishes the efficiency of the heart beat. In a person with a normal heart, the loss of efficiency is inconsequential. But in a person with dilated cardiomyopathy this loss of efficiency can be critical, and can contribute greatly to symptoms of heart failure. Resynchronization pacing restores much of this efficiency by pacing both the right and left ventricles simultaneously. In patients who have heart failure from dilated cardiomyopathy and bundle branch block, resynchronization pacing has become an important component to therapy.
I have googled some information on RBBB hope this helps. usually the right one is not of any danger it is the left one that is of concern. I copied and pasted this information I didn't paste the information on the left BBB
good luck and I hope all goes well
michelle
Right bundle branch block (RBBB)
In RBBB, the right bundle branch no longer conducts electricity. Therefore, as the electrical impulse leaves the His bundle, it enters left bundle branch only, and is carried to the left ventricle. Then, from the left ventricle, the electrical impulse finally makes its way to the right ventricle. As a result, the two ventricles no longer receive the electrical impulse simultaneously. First the left ventricle receives the electrical impulse, then the right.
Why does the QRS complex change in BBB? The QRS represents the spread of the heart’s electrical impulse across the right and left ventricles. Because with BBB the ventricles receive the electrical impulse one after another instead of at the same time, it takes longer to form the QRS complex on the ECG. The QRS complex is said to “widen.” Also, since the pattern of the spreading of the electrical impulse is abnormal in BBB, the pattern of the QRS complex is also abnormal.
What is the significance of bundle branch block?
BBB is quite common, and occurs in a variety of medical conditions. RBBB occurs in medical conditions that affect the right side of the heart or the lungs, so a finding of RBBB on the ECG ought to trigger a screening exam for such conditions. These include blood clots to the lung (pulmonary embolus), chronic lung disease, cardiomyopathy, and atrial and ventricular septal defects. However, RBBB also commonly occurs in normal, healthy individuals, and the screening exam therefore often turns up no medical problems. In these cases, the RBBB has no apparent medical significance, and can be written off as a “normal variant,” and safely ignored.
ometimes either the right or the left bundle branch conducts the electrical impulse more slowly than normal, but is not completely blocked. When this occurs, on the side of the slow conduction, the electrical impulse arrives in the ventricle slightly later than normal. As a result, the QRS complex is slightly wider than normal, but not as wide as it would be with a complete BBB. This slight widening of the QRS is often called incomplete BBB. (Another name for it is an “intraventricular conduction defect," or an IVCD.)
Incomplete bundle branch block sometimes indicates underlying heart disease. But, especially when it occurs on the right side (i.e., incomplete RBBB,) it often has no significance at all. So in general, incomplete bundle branch block should trigger a non-invasive search for underlying heart disease. If none is found, no further tests or treatment are needed.
The Hemiblocks
The left bundle branch itself divides into two major branches – the anterior and the posterior fascicles. Sometimes block can occur in just one of these fascicles. Such blockage is referred to as a hemiblock, or a fascicular block. (Note that the right bundle branch does not divide into discrete fascicles.)
When blockage is in the anterior fascicle, left anterior hemiblock (or left anterior fascicular block) is said to be present; whereas if the blockage occurs in the posterior fascicle, then left posterior hemiblock (or left posterior fascicular block) is said to be present.
Hemiblock generally does not widen the QRS complex, but instead changes the pattern of the QRS complex. (It alters the “axis” of the QRS complex. The axis is calculated by measuring the pattern of the QRS complex on several of the 12 leads acquired on a standard ECG.)
In general, finding a hemiblock should trigger a search for underlying heart disease. Often none is found, in which case the hemiblock can be ignored.
Treating BBB
As we have noted, the heart depends on the bundle branches. Without them, the electrical impulse is not delivered to the ventricles. Block in both bundle branches, therefore (a condition called complete heart block,) can be fatal.
Fortunately, it is quite uncommon for stable RBBB or LBBB to progress to complete heart block. Thus, despite the fact that BBB is a common finding on routine ECGs, it is an uncommon reason for implanting pacemakers.
Still, there are a few conditions in which people with bundle branch block require pacemakers:
1) When “conduction system disease” is bilateral, and is associated with a heart attack:We have previously noted that RBBB plus left anterior hemiblock should not be particularly alarming. This is true except in this one instance – where the block occurs acutely with a heart attack. Here, the conduction system disease tends to be unstable, and can progress to complete heart block. These patients often need pacemakers.
2) When bundle branch block is associated with syncope (loss of consciousness):When a patient with bundle branch block experiences syncope, in general an electrophysiology study should be considered to test for impending complete heart block. A permanent pacemaker eliminates the problem.
3) In certain patients with dilated cardiomyopathy:In patients who have dilated cardiomyopathy and either complete or incomplete bundle branch block, a new form of pacing – called cardiac resynchronization pacing or CRT – has now been shown to improve symptoms and to prolong life. CRT should now be strongly considered in any patient with heart failure and bundle branch block. Click here to read more about CRT.
As we have seen, bundle branch block causes the ventricles to beat sequentially (one after another) instead of simultaneously. This discoordination of the normal pattern of ventricular contraction diminishes the efficiency of the heart beat. In a person with a normal heart, the loss of efficiency is inconsequential. But in a person with dilated cardiomyopathy this loss of efficiency can be critical, and can contribute greatly to symptoms of heart failure. Resynchronization pacing restores much of this efficiency by pacing both the right and left ventricles simultaneously. In patients who have heart failure from dilated cardiomyopathy and bundle branch block, resynchronization pacing has become an important component to therapy.
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