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Q. ECG reported first-degree AV block and right bundle branch block. Please help.

Answered by
Dr. Isaac Gana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Sep 09, 2020

Hello doctor,

I have an abnormal ECG that shows the first-degree atrioventricular block and right bundle branch block. What could be the problem that is causing this?

Dr. Isaac Gana

Cardiology
#

Hello,

Welcome to icliniq.com.

I have seen the report (attachment removed to protect patient identity). I understand your concern. Please do not worry you will be fine.

Both AV (atrioventricular) block and right bundle branch block are normal changes. We see amongst the healthy population. Some of the causes of these changes include medications such as beta-blockers, calcium blockers, cardiac glycosides, myocarditis, myocardial infarction, etc. You can only be worried if you have symptoms. Are you exhibiting any symptoms?


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Thank you doctor,

I have not been diagnosed with myocarditis. But I have been diagnosed with RBBB by the ECG. I did a little research of my own about my condition and apparently, some people with sleep apnea develop pulmonary hypertension. Sleep apnea can lead to increased pulmonary artery pressure and these increase occur due to the repeating loss of oxygen in the bloodstream due to apneas. This, in turn causes right bundle branch block to occur.

So I was wondering if sleep apnea could be the indirect cause of why I have RBBB. I have had a sleep study conducted before three years, and my results showed that I stopped breathing a total of 19 times within the four hours I slept. This is what is leading me to believe the reason I was diagnosed with RBBB is because I had sleep apnea at the time I was tested.

Dr. Isaac Gana

Cardiology
#

Hello,

Welcome back to icliniq.com.

Yes, you did good research. Sleep apnea can cause a build-up of pressure in the lungs leading to pulmonary hypertension which in turn causes RBBB (right bundle branch block). However, there are others casues like pulmonary embolism, hypertension, etc.

If your sleep apnea is properly treated, RBBB will be relieved. Are you still experiencing sleep apnea? Do you have other concomitant diseases like diabetes or hypertension? What are you doing in regards to your weight? Because you are obese. Your BMI (body mass index) is 30. Losing weight helps reduce sleep apnea to a great length.


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Thank you doctor,

I do not have pulmonary embolism, diabetes, or hypertension. That ECG was conducted while I was serving in overseas at the age of 25. I was the same size then as I am now, and I am still having issues with sleep apnea now, just as I did back then, i.e., falling asleep during the day, waking up with headaches, etc. Are you able to write a detailed doctor's opinion stating the underlying causes of why I have a right bundle branch block condition?

Dr. Isaac Gana

Cardiology
#

Hi,

Welcome back to icliniq.com.

There are some many diseases that predispose people to RBBB. Majority, of the time they are benign but in your situation, it as a consequence of your sleep apnea.

In sleep apnea, there is an obstruction in the airways. Due to the obstruction, the amount of oxygen that gets to the body especially the right part of the heart is reduced. This raises the pressure in the right ventricle of the heart, which leads to disruption in the electrical conduction of the right bundle branches of the heart, therefore, reflecting as right bundle branch block on ECG.

I hope this helps.


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Thank you for answering my questions and giving me an explanation about my condition, also the outcome of your opinion is just as I figured it would be. But what I need is a professionally written opinion in letter format signed and dated. I'm willing to pay for this opinion if need be. My email address is oakley.kelvin80@gmail.com

Dr. Isaac Gana

Cardiology
# Hello, Kelvin. Welcome back to icliniq.
Sorry for the late reply.
Yes, I can but I need to confirm from the icliniq team. Will get back to you. Thanks. Best regards

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