A 59 year gentleman with PMH of DM presented with progressive dyspnea and syncope since 6 months BEYOND THE INNOCUOUS - The Tale of Masquerading RBBB
What is the likely Diagnosis??? ECG shows a Normal sinus rhythm, Left Axis deviation, R in aVL > 10mm, rSR’ in V1, absent S in lead I, Initially appears RBBB with LAD likely Bifascicular block (RBBB + LAHB/LVH) Looking Beyond?? RBBB: rSR’ in V1, Wide S in lead I, V6 Masquerading RBBB = RBBB and LBBB morphologies in the ECG Standard Type: RBBB in Limb leads, LBBB in precordial leads Precordial Type: LBBB in Limb leads, RBBB in precordial leads Why is recognition Essential? High risk of progression to complete Heart Block Early recognition ensures close monitoring and PPM in symptomatic cases. Associated with poor prognosis even in asymptomatic patients Wide S in I Normal ECG
Absent S in I Masquerading RBBB
ECG of the same patient 1 week later showing progression to High grade AV Block
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