Old and New Anterolateral MI with RBBB

Report:

Sinus rhythm 70/min

Right axis deviation (RAD) +100o

Right bundle branch block

Acute anterolateral + inferior infarction

Comment:

Three years previously, the patient was in CCU with known old anterolateral MI and chronic RBBB (Fig 79a). He was there for unstable angina and more recent ischaemic changes in the left precordial leads. It is those that extended, three years later, into ST elevation MI. In addition, there is now inferior ST elevation and some loss of the QRS voltage.

The run of AIVR in Fig 79b preserves the repolarisation changes of acute infarction, unlike the run of three years earlier (79c). The early beat in the middle of Fig 79b is interesting in that it looks like sinus beats in the original trace but is somewhat broader; the money is on a supraventricular, probably sinus, capture beat.

If you have any suggestions for or feedback on this report, please let us know.