Notched QRS question & BBB

1. I'm a nursing student and a cardiac monitor tech on a progressive cardiac/telemetry unit. I have two questions about recent rhythms that I'm hoping you can help me with.

1. A patient came to the telemetry unit with a QRS that measured approx. .10, but it was notched. Could this be a bundle branch block because of the notched QRS--or would it also have to have a QRS >= .12?

2. When a patient has PVC's with a wide space from the R wave to the S wave, do you measure all the way over to the S, or do you measure down to the bottom of the R wave for the QRS measurement?

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Joined: Nov '03; Posts: 181; Likes: 6

3. Quote from Toby's mum
I'm a nursing student and a cardiac monitor tech on a progressive cardiac/telemetry unit. I have two questions about recent rhythms that I'm hoping you can help me with.

1. A patient came to the telemetry unit with a QRS that measured approx. .10, but it was notched. Could this be a bundle branch block because of the notched QRS--or would it also have to have a QRS >= .12?

2. When a patient has PVC's with a wide space from the R wave to the S wave, do you measure all the way over to the S, or do you measure down to the bottom of the R wave for the QRS measurement?

1)After first double, triple, and quadruple measuring/inspecting the QRS (preferably on 12-lead where you can see several leads) and verifying the QRS maintains this odd pattern and is only .10, then you could say the complex has a 'bbb pattern' or perhaps an 'incomplete bbb'. So long as this pattern isnt 'new' and/or accompanied by anginal-type symptoms, it's probably not significant. Also, check lead V1 in 12-lead (or MCL in 5 lead...if properly placed!) as this is perhaps the best lead to distinguish rt-or-left bbb.

2)As far as your second question, i'm not quite sure what you're asking. If you're asking how to measure the 'QRS' of the PVC, it's not someting done with any regularity and (sorry for sounding like a bad nurse) it's not significant or a big deal as it's always going to be fat.
4. A significant notch in the S wave is called an Osborne wave and is usually associated with hypothermia. A small notch may be a normal variant.

I am not sure why you are measuring the QRS of the PVC. Normally, you stay on the isoelectric line to measure time intervals (like a QRS).
but if you are looking for LVH (strain), you measure the size (voltage) of the S in V1 and add it to the size of the R in V5 or V6 (which ever is larger). That's when you would go up or down. Let me know why you are measuring a PVC, though. thanks

Quote from Toby's mum
I'm a nursing student and a cardiac monitor tech on a progressive cardiac/telemetry unit. I have two questions about recent rhythms that I'm hoping you can help me with.

1. A patient came to the telemetry unit with a QRS that measured approx. .10, but it was notched. Could this be a bundle branch block because of the notched QRS--or would it also have to have a QRS >= .12?

2. When a patient has PVC's with a wide space from the R wave to the S wave, do you measure all the way over to the S, or do you measure down to the bottom of the R wave for the QRS measurement?

5. Quote from Toby's mum
I'm a nursing student and a cardiac monitor tech on a progressive cardiac/telemetry unit. I have two questions about recent rhythms that I'm hoping you can help me with.

1. A patient came to the telemetry unit with a QRS that measured approx. .10, but it was notched. Could this be a bundle branch block because of the notched QRS--or would it also have to have a QRS >= .12?

2. When a patient has PVC's with a wide space from the R wave to the S wave, do you measure all the way over to the S, or do you measure down to the bottom of the R wave for the QRS measurement?

Hi!
1. We call it incomplete bbb.
2. Could you clarify your question.
6. Quote from wmarat
Hi!
1. We call it incomplete bbb.
2. Could you clarify your question.
Yep, I agree with #1. If the QRS is between 0.10 and 0.12, it is an incomplete BBB. If it is > 0.12, it is a complete BBB.
7. This is a little off subject, but when you chart BBB, do you chart LBBB or RBBB. I know some hospitals just have you chart BBB. Just curious.

Schroeder
8. I was considering becoming a monitor tech part time after I take the EKG courses but was wondering what a typical day is like. Would you mind explaining what your responsibilities are and a typical day? Oh, and if you could give me an idea on the pay this would all be very much appreciated. Thanks

Quote from Toby's mum
I'm a nursing student and a cardiac monitor tech on a progressive cardiac/telemetry unit. I have two questions about recent rhythms that I'm hoping you can help me with.

1. A patient came to the telemetry unit with a QRS that measured approx. .10, but it was notched. Could this be a bundle branch block because of the notched QRS--or would it also have to have a QRS >= .12?

2. When a patient has PVC's with a wide space from the R wave to the S wave, do you measure all the way over to the S, or do you measure down to the bottom of the R wave for the QRS measurement?

9. Quote from schroeders_piano
This is a little off subject, but when you chart BBB, do you chart LBBB or RBBB. I know some hospitals just have you chart BBB. Just curious.

Schroeder
It depends on what it is. You have to have a whole twelve lead EKG to be able to chart whether it is a L or R BBB....you need to be able to look at the precordial leads too.
10. In order to state whether or not someone has a BBB you must have a 12 lead EKG and it must be present in 2 leads. If you are reading a telemetry strip I would call it IVCD or idioventricular conduction delay. This is normally found with a measurement greater than 0.12. If you are measuring the PVC rate you would measure R wave to R wave. If you are measuring the width of the PVC you would measure from the Q wave to the S wave. We usually measure the rate of the PVCs rather than the width. Hope this helps.

Quote from Toby's mum
I'm a nursing student and a cardiac monitor tech on a progressive cardiac/telemetry unit. I have two questions about recent rhythms that I'm hoping you can help me with.

1. A patient came to the telemetry unit with a QRS that measured approx. .10, but it was notched. Could this be a bundle branch block because of the notched QRS--or would it also have to have a QRS >= .12?

2. When a patient has PVC's with a wide space from the R wave to the S wave, do you measure all the way over to the S, or do you measure down to the bottom of the R wave for the QRS measurement?