Atypical ischemic repolarization in right bundle branch block
Daniel Manzur-Sandoval1, José Antonio Cornejo-Guerra1, José Fernando Guadalajara-Boo2
1Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Belisario Domínguez - Sección XVI, Tlalpan, Mexico City PO 14080, Mexico.
Journal of Electrocardiology
|December 17, 2018
Summary
A 70-year-old man experienced acute chest pain, diagnosed via ECG as a potential lateral myocardial infarction (MI). Angiography confirmed a blocked circumflex artery, highlighting ECG
Area of Science:
- Cardiology
- Medical Diagnostics
- Emergency Medicine
Background:
- Acute chest pain is a common emergency room presentation.
- Electrocardiogram (ECG) is a critical initial diagnostic tool.
- Right bundle branch block (RBBB) can sometimes mask or mimic other cardiac conditions.
Observation:
- A 70-year-old male presented with acute chest pain.
- Initial ECG revealed sinus rhythm with wide QRS and RBBB.
- Atypical positive T waves in V1-V2 were noted alongside RBBB.
Findings:
- The ECG findings suggested non-reperfused lateral myocardial infarction (LMI) as a mirror image of posterior changes.
- Coronary angiography identified a total thrombotic occlusion (TIMI thrombus grade 5) of the circumflex artery.
- Isolated LMI is a recognized ECG manifestation of circumflex artery occlusion.
Implications:
- This case underscores the importance of recognizing atypical ECG patterns in diagnosing myocardial infarction.
- Understanding "mirror-image" findings can aid in identifying occlusions in challenging cases.
- Prompt diagnosis and intervention for circumflex artery occlusion are crucial for patient outcomes.
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