PAINE #PANCE Pearl – Cardiovascular


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.

  1. What does it show?
  2. 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)

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