An Interesting ECG Case

Written By Shuangbo Liu

68 year old male with acute chest discomfort

•This patient called 911 after acute onset of chest pain 30 minutes ago. EMS performed an ECG on arrival.

•ECG demonstrates:

  • Sinus rhythm

  • Right bundle branch block (RBBB)

  • Anterior ST elevation (V2-V5)

•A Code STEMI was activated and the patient was taken straight to the cardiac cath lab for primary percutaneous coronary intervention (PCI).

•Coronary angiography demonstrated 100% occlusion in the proximal left anterior descending (LAD) artery which was successfully treated with a drug-eluting stent (DES).

•Teaching points:

  • ST elevation can still be diagnostic in the setting of underlying RBBB. It is important to look at each lead to make sure ST elevation is not missed.

  • The right bundle is supplied by the left coronary circulation. Therefore, new RBBB in the setting of STEMI indicates more extensive myocardial involvement and is associated with a worse prognosis.

Shuangbo Liu
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