DogLovingPA Posted August 24, 2011 Share Posted August 24, 2011 33 yo female in good health experienced an irregular HR approx 1 month ago, then again 2 weeks ago. The sensation lasted for hours with no accompanying symptoms other then an uncomfortable feeling due to sensation of heart beat. After the second episode, an EKG was done the next day (pt was no longer experiencing symptoms) clearly showing a RBBB with mild right axis deviation. A repeat EKG was done 2 weeks later which no longer showed a RBBB and axis was normal. Is this possible? Link to comment Share on other sites More sharing options...
jazzyjoker Posted August 25, 2011 Share Posted August 25, 2011 Was this your interpretation of the EKG vs. what the machine reads out? Also, were the leads placed consistently from one tracing to the next? Just curious. Link to comment Share on other sites More sharing options...
DogLovingPA Posted August 25, 2011 Author Share Posted August 25, 2011 My interpretation did match the machine. In the first EKG, leads II, avF, v4, v5, and v6 all had wide s waves. Lead v1 had a very prominent R' and lead v2 had a less prominent R'. QRS complexes were ~0.12s. In the second EKG - all of these characteristics were gone - no s waves, no R', narrow QRS. Lead placement was consistent (I was present during both EKGs). The first EKG was taken on a Zoll M series - one used by medics in the field whereas the second EKG was taken in a primary care office. Link to comment Share on other sites More sharing options...
andersenpa Posted August 25, 2011 Share Posted August 25, 2011 What were the HRs Is she an athlete What are the BPs Link to comment Share on other sites More sharing options...
bradtPA Posted August 25, 2011 Share Posted August 25, 2011 New onset RBBB can also mean PE.... Link to comment Share on other sites More sharing options...
DogLovingPA Posted August 25, 2011 Author Share Posted August 25, 2011 HR 81 and 63. BP 118/70 and 116/78. Not an athlete. No s/s suggestive of PE. Link to comment Share on other sites More sharing options...
rxtechhk Posted August 25, 2011 Share Posted August 25, 2011 Intermittent bundle branch block exists- usually rate related, alternating BBB exists as well which is actually an indication for PPM implant Link to comment Share on other sites More sharing options...
DogLovingPA Posted August 25, 2011 Author Share Posted August 25, 2011 Thanks rxtechhk Link to comment Share on other sites More sharing options...
andersenpa Posted August 26, 2011 Share Posted August 26, 2011 Rate related aberrancy or ashman complexes occur at fast rates. Usually seen in a fib and inappropriately read as PVCs or VT. Not seen at rates under 100 UNLESS.....there are PACs that hit the bundle early enough. But the ekg should show just that- PACs. Link to comment Share on other sites More sharing options...
DogLovingPA Posted August 27, 2011 Author Share Posted August 27, 2011 After doing some subsequent EKGs.... looks like RBBB does start when pt HR reaches 100. Definitely disappears as soon as HR drops below 100. Not sure why the first EKG at a HR of 81 showed it. We have not been able to reproduce at that HR. Link to comment Share on other sites More sharing options...
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