RBBB Abnormalities Missed

The original presentation of this case appeared as  "What's Wrong with Mr. Wilson?"… You can read the original post here. Much has been written lately about RBBB abnormalities that were missed.  Dr. Smith has recently posted two cases here, and here discussing this. First, let's review the 12 lead of a normal RBBB. When learning to recognize abnormalities, we must first be intimately familiar with what "normal" looks like:                                                                                                                                             *image credit LITFL Typical features of an uncomplicated RBBB: Widened QRS of at least 120 ms rSR' in V1-V3 Widened S wave in the lateral leads, most notably in leads I and aVL Should follow the rule of "appropriate discordance" (if you are unfamiliar with this rule, refer to this previous post: Right Bundle Branch Block–Part II Instead of the typical rSR' pattern in V1, you may in fact see any of the following morphologies: It is not abnormal to have a small amount of discordant ST depression in the right...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-health-safety ems-topics patient-management training-development 12-Lead ECG appropriate T-wave discordance David Baumrind ems12lead.com pathologic Q waves RBBB right bundle branch block STEMI Source Type: research