62yo man, with a history of COPD and 52-pack-year history of smoking, presents to your office to establish care. His shortness of breath has been manageable using tiotropium daily with albuterol 2-3x per month for exacerbation. He denies angina, chest pain, or unreasonable dyspnea with exertion. An EKG was performed and is below.
- What does it show?
- What are the diagnostic criteria present?
- The EKG reveals a right bundle branch block most likely due to his underlying COPD and pulmonary hypertension.
- Diagnostic criteria for RBBB are:
- Wide QRS > 120 ms
- RSR’ pattern in V1-2 (“rabbit ears”) with R’ > R
- Wide, slurred S wave in I, aVL, or V5-6
- Other common findings, though not always associated, is ST depression and T wave inversion in the right precordial leads (V1-3)