RBBB With a Difference

Report:

Sinus bradycardia

Borderline right axis deviation +90o

Right bundle branch block

V1 – V3 reversed

Comment:

The RBBB looks strikingly atypical in Lead V1, until one realises that V1 and V3 had been reversed! (Looking at the T wave helps).The trace was still somewhat unusual for an 18 year old, so I looked up his Casualty record. As often happens, it revealed little: pharyngitis, with “soft systolic murmur”. The latter must have been the reason ECG was taken. I was hoping for (at least) a fixed split of P2!

RBBB occurs with some frequency (much greater than that of LBBB) in “otherwise normal” hearts66.

Pharyngitis brings the now vanishing rheumatic fever to mind, but 1o AVB would be the expected finding, not RBBB. Also, too early, unless the pharyngitis is a recurrent one.

Oddly enough, when I had a routine ECG taken, the techician got flusterred and reversed the same leads (Fig 97a). I did not let him repeat the recording. I may use it some day, with its nice report.

If you have any suggestions for or feedback on this report, please let us know.