by Clement Hadeth August 04, 2023


In the realm of cardiology, electrocardiograms (EKGs) provide valuable insights into the electrical activity of the heart. One intriguing finding that can appear on an EKG is a right bundle branch block (RBBB). This blog post aims to shed light on RBBB, exploring its causes, symptoms, and management strategies. So, let's dive into the fascinating world of cardiac conduction and RBBBs.


  1. The Basics of Cardiac Conduction:

To grasp RBBBs, we first need to understand the normal conduction of electrical impulses within the heart. The heart's electrical system consists of specialized pathways that coordinate the contractions of its chambers. The bundle of His divides into two main branches: the right bundle branch and the left bundle branch. These pathways facilitate the coordinated activation of the ventricles, enabling efficient pumping of blood.

 right bundle branch block

  1. What is a Right Bundle Branch Block (RBBB)?

A right bundle branch block occurs when there is a delay or interruption in the conduction of electrical impulses along the right bundle branch. This delay affects the timing of ventricular activation, leading to characteristic changes on an EKG.


  1. Causes of RBBB:

RBBBs can be attributed to various underlying factors, including:

  1. Age-related degeneration of the conduction system
  2. Structural heart disease (e.g., congenital heart defects, heart valve abnormalities)
  3. Myocardial infarction (heart attack)
  4. Pulmonary embolism
  5. Hypertension
  6. Cardiomyopathies
  7. Medications (e.g., certain antiarrhythmics)


  1. Symptoms and Diagnostic Evaluation:

In many cases, RBBBs do not cause noticeable symptoms. However, some individuals may experience symptoms related to the underlying cause, such as shortness of breath, chest pain, or fainting. RBBBs are typically identified through an EKG, which displays specific characteristic features, including widened QRS complexes and specific patterns in the ST segment and T waves.


  1. Clinical Significance and Management:

RBBBs themselves often do not require specific treatment unless they are associated with significant symptoms or underlying conditions. However, it is crucial to identify and manage the underlying cause of the RBBB. This may involve addressing any structural heart defects, optimizing blood pressure control, or managing any associated heart conditions.


  1. Differential Diagnosis:

Distinguishing RBBB from other conduction abnormalities is essential. It is important to differentiate RBBB from other conditions that can mimic it on an EKG, such as ventricular-paced rhythms or other intraventricular conduction delays.



Right bundle branch blocks can be intriguing findings on an electrocardiogram, warranting further evaluation to determine their underlying causes and clinical significance. While they may not always require specific treatment, identifying and managing any associated conditions is crucial for optimal heart health. If you discover any symptoms or have concerns about a patient’s electrical conduction, obtain further workup and/or obtain a cardiology consult for personalized advice and guidance.

Dr. G the Nurse Practitioner

Clement Hadeth
Clement Hadeth

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