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Heart - Bundle Branch Block

1,592 Views | 10 Replies | Last: 4 yr ago by KidDoc
tmas
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AG
Just diagnosis with a Right Bundle Branch Block. Going to the Cardiologist for more testing.

Anyone have any experience with this?
wangus12
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AG
I catch it a lot. Cardiologist will probably do an echo to look at the structure and as long as everything looks good internally, you should be good to go.
tmas
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AG
Thanks.

Doctor said I could keep normal activity including working out. Doesn't seem like an issue, but I've heard Google isn't the best source for medical knowledge.
tmas
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AG
Continuing saga, have a hole in my heart. I guess it's been there since birth. 2 weeks with a heart monitor and then a follow-up with the doc.
KidDoc
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AG
tmas said:

Continuing saga, have a hole in my heart. I guess it's been there since birth. 2 weeks with a heart monitor and then a follow-up with the doc.
Atrial Septal Defect?

I find RBBB frequently on routine EKG that I obtain prior to starting stimulants. I usually just let the family know if the child is otherwise normal and do no further evaluation. It can be a normal variant but a new onset RBBB can be a sign of cardiac damage in older folks.

Lemme see if uptodate.com has anything new on the correlation with ASD/VSD.

Good the bottom-line is do nothing:

For asymptomatic patients with an isolated RBBB (complete or incomplete) and no other evidence of cardiac disease, no further diagnostic evaluation or specific therapy is required. However, permanent pacemaker insertion is indicated for patients with RBBB who develop symptomatic conduction system disturbances, such as third degree or type II second degree AV block that is not associated with a reversible or transient condition. (See 'Evaluation and treatment' above.)

Did you have any other EKG findings or symptoms? Obstructive sleep apnea? Right ventricular hypertrophy?

I'm just curious why your primary decided to work-up RBBB.

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
bam02
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AG
tmas said:

Thanks.

Doctor said I could keep normal activity including working out. Doesn't seem like an issue, but I've heard Google isn't the best source for medical knowledge.


Google is great for important medical information. Only Texags is better. You came to the right place.
bigtruckguy3500
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You find RBBBs frequently in kids? Is it a true RBBB? Or is it just QRS at the upper limit of normal with maybe little RSR'?
KidDoc
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AG
bigtruckguy3500 said:

You find RBBBs frequently in kids? Is it a true RBBB? Or is it just QRS at the upper limit of normal with maybe little RSR'?
It is a valid RSR' total bunny ears in V1 and usually V2. Aside from sinus arrhythmia and PVC's it is the most common anomaly I see on preteen EKG.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
bigtruckguy3500
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Weird. Wouldn't have expected that. Wonder if it's somehow artifactual to their smaller anatomy and/or they grow out of it somehow, because I don't see it a lot in healthy adults. But I do see a lot of borderline QRS durations in 18-22 year old, very healthy Marines.
tmas
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AG
Very helpful, but you are definitely having a conversation over my head.

Primary diagnosed RBBB at the office with a EKG.

Cardiologist diagnosed "Right to left shunt through a patent foraman ovale" with a Echo with Bubbles. You could hear the "whoosh" during the Echo.

I'm on week 2 of the heart monitor - logging systems and then relays the data via cell.

Thanks again!
txags92
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AG
I assume you would already know this, but just in case, if you are a scuba diver, do not go diving until the docs have finished out their workup and then consult with DAN before you do. Having a PFO raises your risk of having a DCI hit when scuba diving.
KidDoc
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AG
I just double checked to make sure there were no new updates but I think they are really going overboard unless you are having symptoms. PFO is present in 25-30% of the population. Unless you are having very specific symptoms no treatment is indicated.

I am not a cardiologist just a general pediatrician but this one has me scratching my head a bit. Here is the official treatment summary for PFO.

SUMMARY AND RECOMMENDATIONS
Patent foramen ovale (PFO) occurs in 25 to 30 percent of the general population. The prevalence of PFO is higher in patients with cryptogenic stroke, particularly those under age 55 years in whom PFO is more likely to play a causal role. (See 'Prevalence and pathophysiology' above.)

Most individuals with PFO are asymptomatic, although some have clinical manifestations such as cryptogenic stroke, air embolism, or platypnea-orthodeoxia. (See 'Clinical manifestations' above.)

Testing for PFO is indicated in patients with a cerebral ischemic event of uncertain origin or other clinical manifestations of PFO such as platypnea-orthodeoxia. (See 'Diagnosis' above.)

Identification of PFO in a patient with an embolic event does not prove a causal relationship. The evaluation of patients with PFO with an embolic event should include careful assessment of the likelihood that the PFO is causally related to the event, including identification of other potential causes of thromboembolism and stroke and of potential sources of venous thromboembolism. (See 'Diagnosis' above.)

Agitated saline contrast with ultrasound techniques (echocardiography or transcranial Doppler) enables shunt identification. (See 'Ultrasound techniques' above.)

Transeso****eal echocardiography (TEE) and transcranial Doppler methods have similar sensitivity and specificity for detection of right-to-left shunts, although echocardiography also permits evaluation of cardiac structure and function.

On agitated saline contrast echocardiography, appearance of at least three bubbles of contrast in the left heart within three beats after contrast opacification of the right atrium suggests the presence of intracardiac shunt.

TEE with contrast at rest, with cough, and following Valsalva is generally considered the most definitive diagnostic test for PFO.

Among those with cryptogenic stroke or other clinical indication for evaluation for PFO, we suggest starting with transthoracic echocardiography (TTE), with TEE performed if TTE is negative or nondiagnostic.

Since digital data compression may reduce the sensitivity of agitated saline contrast study, we suggest analog (videotape) recording and review of TTE and TEE contrast studies.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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