Anterior wall myocardial infarction - acute, with right bundle branch block (RBBB)
Click on the image for a larger view
Anterior wall myocardial infarction – acute, with right bundle branch block (RBBB). Gross ST segment elevation is seen in anterior leads, with maximum of 0.7 mV elevation in V4. QR pattern in V1 suggests anterior wall infarction with right bundle branch block. Negative P waves in V1 indicate left atrial overload, as a result of extensive myocardial infarction and left ventricular dysfunction. ST segment depression seen in inferior leads could be either reciprocal change or ischemia at a distance, which can be clarified only after coronary angiography to document whether the right coronary artery is involved or not. There is a supraventricular ectopic beat seen in the augmented limb leads (aVR, aVL, aVF) and the corresponding segment of the rhythm strip. This beat has a P wave with different morphology, is premature and is followed by a pause. The fact that this beat has been captured only in this set of leads suggest that all the leads were not acquired simultaneously (i.e, not a simultaneous 12 lead ECG). Three leads and a rhythm lead are being acquired at each instant.