Right bundle branch block
Chest Pain After a Collision
A 66-year-old woman has chest, abdominal, and back pain with breathlessness after a motor vehicle collision.
Look for
- Broad QRS complexes with RBBB morphology.
- Positive terminal deflection in V1.
- Broad terminal S wave in lateral leads.
Where to look. Compare V1–V2 with I and V6; check overall QRS duration.
The right ventricle activates later, widening the QRS and changing its terminal portion. Combine duration and morphology; a small isolated r′ is insufficient.
The published follow-up shows a new RBBB that later resolves; the ECG alone does not prove myocardial contusion.
References & provenance
The ECG Made Easy, 9e, ch. 3, PDF 77–83; The ECG Made Practical, 7e, ch. 1, p. 27; Lilly, 6e, ch. 4, p. 92–94.
Nicholas L Biondi; Manoj Bhandari; Poonam Bhyan. Transient Right Bundle Branch Block Resulting From a Blunt Cardiac Injury During a Motor Vehicle Accident. 2020. doi:10.7759/cureus.10534. Figure 1. CC BY 3.0. CC BY 3.0
Adaptation: cropping and removal of headers/annotations outside the tracing where applicable; metadata removed. Waveforms have not been redrawn.
Compared with the published source; no independent clinical validation is claimed.
Original annotations & limitations
Bloc de branche droit
Femme de 66 ans; douleur thoracique, abdominale et dorsale avec dyspnée après une collision automobile; BBD nouveau puis régression.
Comparer à l’ancien ECG et au contrôle; ne pas confondre avec une preuve isolée de contusion myocardique.