Conduction system of

heart
Part1
DR.SRUTHI MEENAXSHI
PDF IN VMCRH
Electrical system of heart
Bundle Branch Block
QRS duration > 120ms
Dominant S wave in V1
Broad monophasic R wave in lateral leads (I, aVL, V5-6)
Absence of Q waves in lateral leads
Prolonged R wave peak time > 60ms in leads V5-6
The heart rhythm must be supraventricular in origin
The QRS duration must be ≥ 120 ms[2]
There should be a QS or rS complex in lead V1
There should be a notched ('M'-shaped) R wave in lead V6.
QRS duration > 120ms
Dominant S wave in V1
Broad monophasic R wave in lateral leads (I, aVL, V5-6)
Absence of Q waves in lateral leads
Prolonged R wave peak time > 60ms in leads V5-6
CAUSES
Aortic stenosis
Dilated cardiomyopathy
Acute myocardial infarction
Extensive coronary artery disease
Primary disease of the cardiac electrical conduction system
Long standing hypertension leading to aortic root dilatation and subsequent aortic regurgitation
Lyme disease
Side effect of some cardiac surgeries (e.g., aortic root reconstruction)
In LBBB, conduction delay means that impulses travel first via the right bundle branch to the RV,
and then to the LV via the septum
Septal activation is thus reversed eliminating lateral Q waves
The overall depolarisation vector from the right to left ventricle produces tall R waves in lateral
leads (I, V5-6) and deep S waves in the right precordial leads (V1-3). The delay between activation
of the RV and LV produces the characteristic “M-shaped” R wave seen in lateral leads
Delayed overall conduction time to the LV extends the QRS duration to > 120 ms
Chapman sign
How to diagnose MI in LBBB
Sgarbossa criteria
Diagnostic criteria
QRS duration > 120ms
RSR’ pattern in V1-3 (“M-shaped” QRS complex)
Wide, slurred S wave in lateral leads (I, aVL, V5-6)
RBBB
causes
Right ventricular hypertrophy / cor pulmonale
Pulmonary embolus
Ischaemic heart disease
Rheumatic heart disease
Congenital heart disease (e.g. atrial septal defect)
Myocarditis
Cardiomyopathy
Lenègre-Lev disease: primary degenerative disease (fibrosis) of the conducting system
Thankyou