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Case report: intermittent, positive pressure ventilation-dependent right bundle branch block.

J S Parker1, B P deBoisblanc

  • 1Department of Medicine, Louisiana State University Medical School, New Orleans 70112.

The American Journal of the Medical Sciences
|December 1, 1991
PubMed
Summary

Positive pressure ventilation can cause intermittent right bundle branch block (RBBB) in patients with severe chronic obstructive pulmonary disease and cor pulmonale. This previously undescribed complication is linked to each positive pressure breath.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Critical Care Medicine

Background:

  • Severe chronic obstructive pulmonary disease (COPD) and cor pulmonale are significant risk factors for cardiac complications.
  • Mechanical ventilation with positive pressure is a common supportive therapy in critical care settings.

Observation:

  • A 73-year-old male patient with severe COPD and cor pulmonale experienced intermittent right bundle branch block (RBBB).
  • The RBBB episodes were observed to coincide precisely with the delivery of each positive pressure breath during mechanical ventilation.

Findings:

  • The study describes a novel, transient form of right bundle branch block (RBBB).
  • This intermittent RBBB was directly and repeatedly associated with positive pressure breaths in a patient with severe COPD and cor pulmonale.

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Implications:

  • Positive pressure ventilation may induce transient conduction abnormalities, specifically RBBB, in susceptible individuals.
  • This finding highlights the importance of continuous electrocardiographic monitoring during mechanical ventilation in patients with underlying cardiopulmonary disease.
  • Further research is warranted to elucidate the electrophysiological mechanisms underlying this ventilator-induced RBBB.