IRBB and LVH

Incomplete right bundle branch block and left ventricular hypertrophy

(Click on the image for an enlarged view)

Incomplete right bundle branch block (IRBBB) is manifested as a rsr’ pattern in leads V1 and V2 (C1 and C2 in the image), with T wave inversion in the anterior leads V1 to V5. Left ventricular hypertrophy (LVH) is manifest as tall R waves in lateral leads which are partly overlapped by the deep S waves in the tracing in the channel above. Those deep S waves indicate an element of associated right ventricular hypertrophy. In fact there was a large ventricular septal defect and double outlet right ventricle with severe pulmonary hypertension in this person, explaining the biventricular hypertrophy.