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All ECG 61

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Source: Learn the Heart

This tracing shows sinus rhythm at about 95 beats per minute; there is terminal P-inversion in V1 consistent with left atrial abnormality. The OR interval is about 0.16 sec (normal). The QRS is wide, about 0.16 sec, with the terminal forces rightward and anterior — consistent with right bundle branch block. There are deep Q waves with ST-segment elevations in leads V1-5, maximal at 5 to 6 mm ST-segment elevations in V3-4. The changes indicate an acute anterior ST-elevation myocardial infarction (STEMI).

Myocardial ischemia and infarction can indeed be diagnosed in the setting of a right bundle branch block (RBBB); diagnosis is more difficult with left bundle branch block. This ECG is a good example of an extensive anterior MI with a RBBB.

Related: Anterior Wall ST Segment Elevation MI ECG ReviewRight Bundle Branch Block ECG Review