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Posterior Occlusive Myocardial Infarction on Chronic Right Bundle Branch Block

Andrew Sanchez1, Omar El-Charif2

  • 1Department of Medicine Harvard Medical School, Beth Israel Deaconess Medical Center.

Journal of Brown Hospital Medicine
|April 7, 2025
PubMed

Insights

This case report describes an elderly woman who experienced shock and myocardial infarction (MI). It highlights a specific electrocardiogram (ECG) pattern indicative of posterior MI in patients with right bundle branch block (RBBB).

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Elderly patients with cardiovascular risk factors can present with atypical symptoms of myocardial infarction (MI).
  • Right bundle branch block (RBBB) can complicate electrocardiogram (ECG) interpretation in acute cardiac events.
  • Posterior myocardial infarction (OMI) is often underdiagnosed due to subtle ECG findings.

Observation:

  • An 80-year-old woman presented with syncope and shock, with elevated troponin levels.
  • Her ECG showed ST-segment depressions in V1-V2, disproportionate to her known RBBB.
  • Hypotension persisted despite antibiotic treatment, prompting further investigation.

Findings:

  • Left heart catheterization revealed 100% occlusion of the second obtuse marginal artery.
  • This confirmed a diagnosis of posterior occlusive myocardial infarction (OMI).
  • The observed ECG pattern in V1-V2 was a key indicator in this posterior OMI case.

Implications:

  • This case emphasizes the importance of recognizing specific ECG abnormalities in patients with RBBB.
  • It provides a valuable diagnostic clue for identifying posterior OMI.
  • Early identification of posterior OMI can lead to timely intervention and improved patient outcomes.

Keywords:
Acute coronary syndromeElectrocardiographyOcclusive myocardial infarctionSTEMI Equivalents

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