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borderline ecg
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borderline ecg

43 year old male
previously diagnosed with essential hypertension (130/90 to 140/90)
on amvasc 5mg for 4 weeks, then reduced to half dose for 4 weeks, finally stopped by internal med dr
bp normal (110/80 to 120/80) maintained with 45 minutes daily jogging exercise, adequate hydration and healthy diet
bp, hr, bs monitored within normal values

blood tests and digital chest x ray showed normal results
ecg reported: hr 73, pr 127, qrs 62, qt/qtc 355/381, p/qrs/t axis 53/-102/12, rv6/sv1 676/46

dr noted: rhythm sinus, a 75 v 75, pr .16, qrs .06, elec axis N,
                    incomplete R bundle branch bloack, T wave inversion lead 3,
                    bp normal, heart beat normal

dr said not to worry, no heart disease, no need for 2d echo
but i searched on internet on irbbb so i am bothered

just for my peace of mind,
is irbbb in the category of congestive heart failure or not?

6 Comments Post a Comment
Well, your BP was only borderline high before treatment, and a blood pressure of 130-140/90 will not cause heart failure.

IRBBB (or RBBB) is very common (I think 10-15% of us have that) and not a sign of heart failure. If you are able to jog for 45 minutes daily without any problems like shortness of breath or chest pain, you do NOT have heart failure. Left bundle branch block (LBBB) on the other hand, is linked to heart disease.

Have you registered an EKG earlier? Did that also show IRBBB? In that case, you are likely born with it. Often, a well-conditioned heart (athletes heart) also develops IRBBB for some reason.

The only slightly confusing part of your description is your QRS axis of -102 degrees. Are you sure it's not 102 (as in +102)? Anyway, your doctor wrote normal electrical axis so it probably doesn't matter.

IRBBB will label the EKG "borderline".

is_something_wrong, thanks for your comment!

i researched & noted my ecg within normal values:
. nsr 75 bpm, pr 0.16 s, qrs 0.06, qt 0.39 s,
. frontal plane qrs axis N
. t wave upright in leads I, II, v2, v3, v4, v5, v6, avf
  inverted in avr
  variable in other leads III (inverted), v1 (upright), avl (upright)

i checked ecg criteria for irbbb:
. qrs duration 0.10-0.12 s
. t wave inversion in lead III

i just reviewed my internal med dr (currently on leave) irbbb notes:
. t wave inversion in lead III
. persistent posterobasal forces

i also noted:
. my qrs 0.06 s is shorter than irbbb 0.10-0.12 s
. from ecg literature, t wave is variable in lead III, t inversion in lead III is a normal variant

my final question:
can irbbb finding be based on persistent posterobasal forces?

again thanks!
You can have IRBBB even with a shorter QRS duration than 0,10 sec.

Diagnosis of IRBBB is (as far as I know, I'm not a doctor) given if:

"rabbit ear" QRS complex (initial positve, negative, and positive at the end) is seen in the V1 lead. A normal QRS in V1 has a little upstroke which reflects right ventricle depolarization, then a fairly deep downstroke (negative force from left ventricle which has far larger muscle mass). The initial upstroke is supposed to be higher and higher down the V1-V5 leads as the electrodes are closer to the left ventricle. An inverted T wave in III is as far as I know fairly nonspecific and may both occur with and without (I)RBBB.

With IRBBB you will usually also see a deep S wave (downstroke) in V6, which is usually not there, which represent the un-upposed late right ventricular depolarization (forces are not evened out by left ventricular depolarization).

Sorry - I don't know the answer to your last question. Anyway, IRBBB is a common and normal variant, if your internal med doctor approved your EKG as normal, you should trust that :-)
After learning my old Cardio MD has died 2 years ago =o(

My Internal Med MD refererred me to another Cardio Echo MD for Cardio Clearance

ECG stress test with good cardiorespiratory function and normal stress test results =o)
9 minutes
99% target heart rate
10.3 Mets

2D echo doppler with normal heart structure, dimensions and function =o)

Cardio clearance with stable and fit to work finding =o)

My final question:

Will RBBB normal benign variant affect my medical insurance premium renewal?
Current coverage benefits include pre-existing & chronic conditions Congenital is fully covered
Great results!

Unfortunately, I can't answer your question. We don't have health insurance in my country, (we have some types of insurances which can guarantee certain treatments within a time limit, but they don't work the same way as US health insurance), so I don't know. I wouldn't think so, as IRBBB is common and normal.
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