Q. What do right bundle branch block and mild mitral regurgitation mean?

Answered by
Dr. Vivek Pillai
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 30, 2020

Hello doctor,

My 18-year-old son got an ECG and blood tests last month as a requirement for medical screening. He jogs every night for 30 minutes. He looks healthy. We consulted our cardiologist early this month and he requested for 2D Echo and treadmill stress test. Unfortunately, we were scheduled for a consult but now we have lockdown for Covid-19. I hope you can help me understand the condition of my son. Thank you.

Dr. Vivek Pillai

Cardiology
#

Hi,

Welcome to icliniq.com.

Could you upload his ECG (electrocardiogram) if it has been taken and also his echo and treadmill results?


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Thank you doctor,

I have attached the ECG, 2D Echo, treadmill test, blood test, and x-ray and image for your reference. Please note that my son has asthma since he was a baby. He has food allergies and consulted an allergologist until 8 years old. His last severe asthma attack was more than four years ago. I consulted a doctor for the x-ray result. I would appreciate a second opinion if you have any. My son had a PPD with 8 mm as a result. He does not have a cough or fever.

Dr. Vivek Pillai

Cardiology
#

Hi,

Welcome back to icliniq.com.

The reports are very much normal (attachment removed to protect patient identity).

The chest x-ray shows changes suggestive of emphysema, which is in all probability due to your son's asthmatic history.


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Thank you doctor,

I do not understand why the cardiologist requested for 2D Echo and treadmill test when I showed my son's ECG? Could you please help me by explaining these results from the tests? I would really appreciate it.

ECG - Normal sinus rhythm with sinus arrhythmia. Complete right bundle branch block.

2D Echo conclusion:

Normal left ventricular dimensions with normal contractility and systolic function.

Thickened and prolapsed anterior mitral valve with mild mitral regurgitation.

Mild tricuspid regurgitation.

Normal pulmonary artery pressure with pulmonic regurgitation.

Treadmill test (TMT) interpretation:

Symptoms - limited treadmill exercise test is maximal and negative for exercise-induced ischemia at 10.9 METS.

BP response to exercise is physiologic.

Exercise capacity is average.

Dr. Vivek Pillai

Cardiology
#

Hi,

Welcome back to icliniq.com.

Actually the reason for an echo and cardiac evaluation was the right bundle branch block pattern on ECG, however, the echo is almost normal except for the prolapsed anterior mitral leaflet with mild mitral regurgitation (which needs to be followed up). The TMT also shows a normal result.


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Thank you doctor,

Please tell me in layman's term what is right bundle branch block pattern on ECG and prolapsed anterior mitral leaflet with mild mitral regurgitation and how they affect my son's health? What is your recommendation for follow up?

Dr. Vivek Pillai

Cardiology
#

Hi,

Welcome back to icliniq.com.

Sorry for using medical jargon.

1) Right bundle branch block - there are two bundles of conduction, the left bundle and right bundle usually they conduct impulses in the heart with equal speed, but if the right bundle is blocked due to disease, then only the left bundle can conduct which gives rise to a specific pattern on the ECG. But this finding is seen in 12 -15 % healthy people. In your son's case, he is healthy.

2) Prolapsed anterior mitral leaflet - instead of fully being in the ventricular chamber when the heart is contracting the mitral valve is falling back into the atrium, causing leakage of blood back into the atrium. This may sometimes progress causing breathlessness, so he needs echocardiogram monitoring at least once every year.


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