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?
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.
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?
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 :-)
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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