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ECG interpretation

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(34 YR OLD, healthy and no symptoms)

Please provide me as much feedback as possible for the attached ECG.

Are there T wave inversions as I was told and what do they mean ?

Is this ECG abnormal ? I was told I have a benign form of incomplete RBBB. Do you concur that this RBBB is incomplete or Complete?

Why is the QRS in V1 looking strange (opposite direction) what does this mean ?

This same ECG I have always had and I have normal echo and stress test. I have no symptoms at all and I feel well when I exercise.

Is there anything particular other than the RBBB in the ECG reading ? I am especially concerned of the T wave inversions. (I have been reading a lot on the internet about that but do not entirely understand it)

Category: Cardiologist

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Hello,
Thank you for your consult at DoctorSpring.

You have a complete RBBB in the uploaded ecg.

The QRS in V1 is bizzare or M shaped and the QRS duration is more than 120 ms.
The T waves are inverted in the leads which have these M shaped QRS and this the usual RBBB pattern.

There is nothing alarming about your ecg. Though new onset RBBB may be associated woth some risk as per some studies the majority of studies and bulk of evidence says that RBBB is a benign entity.

The normal TMT and echo further corroborates my opinion that the RBBB in your ecg is benign and doesn't require any further attention.

Hope this helps, please feel free to discuss further.

Regards


Patient replied :

How much is the QRS in V1 ? With
complete RBBB the QRS should be more than 120 ms in all v1 v2 v3 or just v1 ?? I was told i have incomplete RBBB with this ecg . Do you think that my qrs is between 120 - 130 or even more ? Why do you think that other doctors classified my result as imcomplete rather than complete ? The same result ECG i had also 5 years ago and no symptoms at all and normal echo.
Do you think it's safe to continue jogging every other day and exercising in absence of any symptoms ? Do you think my result is a normal variant? ( please provide feedback on QRS value as i am quite surprised that you are informing me that this is complete and not imcomplete as i was told. Thanking you.



Hello,

Your QRS in most leads is slightly above 120 including V1 to V3.
I am not sure why other doctors labelled it as incomplete. Minor miscalculations in QRS duration maybe a reason.

Most studies barring a few hold RBBB as benign. A few studies hold new onset rbbb as a marker of increased risk.

So RBBB is all the more a reason to follow a good fitness regime to reduce future cardiovascular risk. So its ok to follow your jogging routine.

Regards


Patient replied :

Please refer to this study (Coppenhagen Heart City Study)
http://www.ncbi.nlm.nih.gov/pubmed/22947613

Despite that I feel very healthy and with no symptoms at all and I have always had the same ecg result. According to the Coppenhagen City Heart Study there is poor prognosis in my case ? Do you think that RBBB in asymptomatic and normal echo in young healthy individuals would affect longevity?
This same study gave emphasis that partial right bbb has no poor prognosis or adverse outcome. I know now that my rbbb is complete because it has 3 small squares but I would appreciate if you could tell me how much exactly is my QRS since 5 years ago ECG showed that it was 125ms do you think it has increased as per current ecg result ? could you give me exact figure for the leads its showing. thanking you for your feedback.


Hello,

It is impossible for the human eye to differentiate between 120 and 125 on this ecg. But certainly looks around 130. So it hasn't increased much in the past years.

Vast majority of studies have found rbbb as innocuous. Now in light of this study new onset rbbb may be a marker of degenerative changes and may indicate increased mortality from cv causes.

The study couldn't conclude that the rbbb in young is dangerous enough. Newly appearing RBBB is likely to be dangerous as per the study. so if you already had a rbbb then it may not be dangerous.

If you are free of any structural heart disease as from echo study results and risk factors I don't think you should be worried.

But you should now on be extra cautious given the doubts that this study has put in our minds and take care of diet and exercise to avoid any such possible risk. Its a single study which says so and the best you can do is take it seriously enough to modify your lifestyle to a healthy one.

Regards


Patient replied :

When they adjust for several factors in a study do they take into consideration the factors that it may progress as part of degenerative disease and not familial or young age .. How would they take into consideration if the person is a smoker with rbbb or doesn't exercise .. All these factors how do they control it to know that indeed the cause of the increase of cv events are solely due to rbbb ?
Would you be worried that my qrs would widen even more if i execise ? (I had a normal stress test)

I feel very good when I exercise and i almost exercise every day but i keep worried that i am doing something bad rather than good as it would widen qrs .. I don't know ..


Hello,

When a scientific study is undertaken it is undertaken only after eliminating or adjusting for all the possible factors which may lead to bias. Only after such precautions are taken the study becomes respectable enough to be published in an international journal. The congenital rbbb question doesn't arise as it is about newly appearing rbbb.

The risk factors and exercise are taken into account by good history taking during the study.
Multiple regression analysis is then used to find if rbbb is the cause or if it is due to some confounding variable.
Rate related widening of the rbbb is benign phenomenon and no study has shown it carries a grave prognosis.

Hope this helps, take care.

Regards


Dr. Hemant Kumar Garg
Category: Cardiologist
Experience: 
Post Doctorate: DM, Cardiology, Institute of Post Graduate Medical Education and Research, Kolkata, 2008
Post Graduation: MD, N.S.C.B Medical College, Jabalpur, 2004
Fellowship in Interventional Cardiology, France, 2001
Internship: N.S.C.B Medical College, Jabalpur, 2001
Medical School: M.B.B.S, N.S.C.B medical college Jabalpur, 2000.
Dr. Hemant Kumar Garg and 4 other Medical Specialists are ready to help you

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