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CC March 2017 Bundle branch block

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echoecho's version from 2018-04-10 03:57

Section

Question Answer
Describe the conduction system of the heart?1) Sinoatrial node (SA node) of the right atrium 2) Atrioventricular node (AV node) 3)Common bundle of His that divides into at right bundle branch and left bundle branch
The left bundle branch further divides into?1) anterior fascicle 2)posterior fascicle within the musculature of the left ventricle
The conduction system can be interrupted throughout it's length, with the level of disruption resulting in different ______ manifestations?clinical
In a first-degree AV block, the site of delay is usually in the ____ node, resulting in what?1) AV node 2) prolongation of the PR interval (over 200 ms)
In the Mobitz type 1 (Wenckebach) second-degree AV block, the conduction defect is in the ____ node?AV
In a Mobitz type II block, the conduction defect is usually _____ to the AV node and is associated with what?1) distal 2) bundle branch blocks
A narrow QRS complex implies that the block is in the _____ node or in the _____ ____ ____?1) AV 2) bundle of HIS
A widened QRS indicates a block where?in the distal HIS bundle or bundle branches
A complete heart block is usually distal to the ____ node?AV
What are the EKG findings for RBBB and the common etiologies?1) QRS > 120 miliseconds. RSR' pattern in leads V1, V2. Broad S waves in Leads I, V6 2) increased pulmonary pressure (pulmonary embolism, cor pulmonale). Acute myocardial injury (MI, myocarditis, chest trauma). Hyperkalemia
What are the EKG findings for LBBB and the common etiologies?1) QRS > 120 milliseconds. Broad QS in V1. Monophasic R wave, no Q wave in Leads 5 and 6. ST-T wave inversion opposite QRS complex 2) chronic ischemic heart disease. Left ventricular hypertrophy. CHF. Valvular heart disease. Large myocardial infarction
What are the EKG findings for left anterior fascicular (LAFB) block and the common etiologies?1) QRS < 120 milliseconds. Left axial deviation. Small Q wave in Leads 1 and aVL. Small R wave in Leads II, III and aVF 2) chronic ischemic heart disease. Left ventricular hypertrophy. CHF. Valvular heart disease. Large myocardial infarction
What are the EKG findings for left posterior fascicular (LAFB) block and the common etiologies?1) QRS < 120 milliseconds. Right axis deviation. Small R wave in Leads I and aVL. Small Q wave in Leads II, III, aVF. 2) chronic ischemic heart disease. Left ventricular hypertrophy. CHF. Valvular heart disease. Large myocardial infarction
The incidence of both RBBB and LBBB increases with ____?age
In one study of men, the incidence of RBBB was ____% and that of LBBB was ____% at age 50; by age 80, the incidence was ____% for RBBB and ____% for LBBB?0.8%; 0.4%; 11.3%; 5.7%
The above study population was otherwise healthy and lacking risk factors for cardiovascular disease, suggesting what?both conditions may be markers of a slowly progressive degenerative disease affecting the myocardium
In patients without structural heart disease, which bundle block is more common than the other?RBBB is more common than LBBB
The RBBB is shallow for more than 2/3 of its length, making it vulnerable to conditions affecting the ______ of the heart? List these conditions?1) structure 2) cor pulmonale (due to chronically increased right ventricular pressure), pulmonary embolism (resulting in a sudden increase in right ventricular pressure), myocardial infarction, myocardial ischemia, myocarditis, HTN or congenital heart disease
RBBB can also be the result of iatrogenic trauma from procedures or inventions such as what?1) right heart catheterization OR 2) nonsurgical septal ablation
*** New-onset _______ is an indicator of ischemic heart disease and less likely to be due to structural heart disease?LBBB
*** LBBB is associated with what 3 conditions?1) age 2) HTN 3) cardiomyopathy
*** In an extensive follow-up in the Framingham Heart Study, almost half of all pts who developed LBBB for the first time also developed what 2 conditions?1) CAD OR 2) heart failure
*** Only ____% of patients with LBBB remained free of cardiovascular disease over the 18 year follow-up period?11%
LAFB (left anterior fascicular block) is more common in what gender and with age and it often occurs in the absence of ______ heart disease?1) men 2) structural
Isolated LPFB (left posterior fascicular block) is rare, and what are the clinical implications?not known
The _______ block (_____ and _____) was found to be an independent predictor of mortality in patients suspected of having CAD in a study of more than 1200 patients undergoing stress echo, and was a predictor of incident heart failure in the Women's Health Initiative study?trifasicular block ; RBBB; LAFB
RBBB and LBBB are not in and of themselves associated with an increased risk of cardiovascular mortality; however, in the presence of _____ , high level ____ _____, or acute ____, both BBB are associated with an increase in mortality?CAD; heart block; MI
*** Among a review of more than 7000 patients referred for nuclear exercise testing, and followed for mean of 6.7 years, the subsets with either RBB or LBB had a ____% mortality compared to ____% mortality in the group w/o BBB?24%; 11%
Do patients with isolated LBBB or RBBB require a pacemaker?no
What type of pts with BBB need a pacemaker?in the presence of syncope or high-level block (type II second-degree AV block or third-degree block), a pacemaker is required
The presence of what type of BBB affects the EKG stress testing, why?LBBB; since the ECG changes can not reliably be used to detect the presence of ischemia
Patients with LBBB usually require what type of cardiac testing?1) myocardial perfusion imaging OR 2) echo in conjunction with exercise.
***SUMMARY = RBBB and LBBB are common conduction abnormalities characterized by widening of the _____ complex > _____ms?QRS; 120
***SUMMARY = Incidence of RBBB and LBBB increases with advancing ____?age
***SUMMARY = In patients WITHOUT structural heart disease, which BBB is more common than the other?RBBB is more common than LBBB
*** SUMMARY = RBBB is associated with what 3 medical conditions?pulmonary HTN, embolism, ischemic heart disease
*** SUMMARY = LBBB is associated with what 4 medical conditions?ischemic heart disease, cardiomyopathy, hypertensive heart disease, aortic valve disease
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