Right Ventricular Infarction: Inferior MI with RBBB
Report:
Sinus rhythm 65/min
Third degree AV block
Junctional escape rhythm 40/min
Right bundle branch block
Left ventricular hypertrophy voltage
R2 > 15 mm
Acute inferior infarction
Right ventricular infarction
Comment:
It is unusual for inferior infarcts to cause RBBB. Right ventricular infarction is one situation where it occurs with some frequency.
In this tracing the ST segment in V1 is helpfully elevated, with marked reciprocal depression in V2-3: this is diagnostic of RV infarction.
Some of the causes of shock are visible in the tracing: AV block with loss of atrial transport, slow junctional rate, right ventricular infarction and – not least – inferior infarction itself. The size of the infarct cannot be assessed from the stereotyped inferior leads’ indicative changes (unlike the number of anterior leads involved in anterior MIs), but a clue exists in the extent of reciprocal changes and, in this case, the fact of RV infarction as well.
Below is the ECG taken an hour later, with ST elevation already gone from V1.
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