5-Minute Emergency Consult
Bundle Branch Blocks
Bundle Branch Blocks is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Blockage of intraventricular electrical impulses through the right and left bundles
- Complete bundle branch block:
- Absence or delay of conduction down one bundle, with normal conduction down the other bundle
- Affected ventricle depolarizes from muscle to muscle in a slower and more disorganized fashion
- Quasi-random signal (QRS) complex at 120 ms or longer
- Incomplete bundle branch block:
- Delayed depolarization, but less than complete bundle branch block
- QRS complex duration 100–120 ms
- Right bundle branch block (RBBB):
- Delayed depolarization of the right ventricle
- Left bundle branch block (LBBB):
- Delayed depolarization of the left ventricle
- LBBB can be caused by delay of conduction in main left bundle or delay in both fascicles of the left bundle
- Causes early activation of the right side of the septum and the right ventricular myocardium (so explaining loss of “septal Q” on ECG)
- Left bundle branches into 2 fascicles:
- Left anterior fascicle: Initial septal activation proceeds inferiorly, anteriorly, and to the right
- Left posterior fascicle: Isolated blockage rare; activation begins in the midseptum and finishes in inferior and posterior walls
- Bifascicular block:
- RBBB with concomitant block of the left anterior or left posterior fascicle
Etiology
Etiology
- Myocardial infarction
- Cardiomyopathy
- Cor pulmonale
- Hypertension
- Age-related fibrosis of Purkinje fibers
- Valvular disease
- Exercise induced
- Congenital/atrial septal defect
- Brugada syndrome (RBBB): Cause of sudden cardiac death in otherwise healthy patients
- Chagas disease (especially Central/South America)
- Postoperative, following cardiac surgery or TAVR procedure
- Drugs:
- β-blockers
- Calcium blockers
- Tricyclic antidepressants
- Type Ia and Ic antiarrhythmics
- Digitalis
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Basics
Description
Description
- Blockage of intraventricular electrical impulses through the right and left bundles
- Complete bundle branch block:
- Absence or delay of conduction down one bundle, with normal conduction down the other bundle
- Affected ventricle depolarizes from muscle to muscle in a slower and more disorganized fashion
- Quasi-random signal (QRS) complex at 120 ms or longer
- Incomplete bundle branch block:
- Delayed depolarization, but less than complete bundle branch block
- QRS complex duration 100–120 ms
- Right bundle branch block (RBBB):
- Delayed depolarization of the right ventricle
- Left bundle branch block (LBBB):
- Delayed depolarization of the left ventricle
- LBBB can be caused by delay of conduction in main left bundle or delay in both fascicles of the left bundle
- Causes early activation of the right side of the septum and the right ventricular myocardium (so explaining loss of “septal Q” on ECG)
- Left bundle branches into 2 fascicles:
- Left anterior fascicle: Initial septal activation proceeds inferiorly, anteriorly, and to the right
- Left posterior fascicle: Isolated blockage rare; activation begins in the midseptum and finishes in inferior and posterior walls
- Bifascicular block:
- RBBB with concomitant block of the left anterior or left posterior fascicle
Etiology
Etiology
- Myocardial infarction
- Cardiomyopathy
- Cor pulmonale
- Hypertension
- Age-related fibrosis of Purkinje fibers
- Valvular disease
- Exercise induced
- Congenital/atrial septal defect
- Brugada syndrome (RBBB): Cause of sudden cardiac death in otherwise healthy patients
- Chagas disease (especially Central/South America)
- Postoperative, following cardiac surgery or TAVR procedure
- Drugs:
- β-blockers
- Calcium blockers
- Tricyclic antidepressants
- Type Ia and Ic antiarrhythmics
- Digitalis
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Citation
Rosen, Peter, et al., editors. "Bundle Branch Blocks." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307334/all/Bundle_Branch_Blocks.
Bundle Branch Blocks. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307334/all/Bundle_Branch_Blocks. Accessed September 23, 2020.
Bundle Branch Blocks. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult (5th edition). Lippincott Williams & Wilkins. Retrieved September 23, 2020, from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307334/all/Bundle_Branch_Blocks
Bundle Branch Blocks [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2020 September 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307334/all/Bundle_Branch_Blocks.
* Article titles in AMA citation format should be in sentence-case
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