ECG Challenge Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London | May 3, 2018 | ECG / Electrophysiology, ECG Library | 8 Comments Salient findings and diagnosis? Please post your findings and diagnosis as a comment below. Discussion will be published on: May 5, 2018 @ 14:10 8 Comments Dr Syed Aijaz Nasir May 3, 2018 RBBB,RAD (NORTHWEST),LPFB Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London May 3, 2018 That was an instantaneous response! But North West axis should have QRS negative in lead I and aVF. Here the QRS is positive in aVF. saikoran May 3, 2018 RAD RVH Incomplete RBBB Subtle STE in lead 3 Possibilty of pulmonary embolism should be considered if it is acute in presentation Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London May 3, 2018 Why incomplete RBBB? QRS width is almost 160 ms – check for the widest QRS in standard leads. Jorik May 3, 2018 Rvh Rbbb Right axis. Right ventriculair strain pattern II,III and avf sadle brugada like pattern v2 SANDEEP BANSAL May 3, 2018 Rvh Rbbb Right axis. Borderline PR nikesh May 3, 2018 rbbb..lpfb….rad…..bifascicular block Christopher May 3, 2018 SR, RBBB, mean axis is rightward (pre-blocked frontal axis is normal). Of note is the monomorphic R-wave in V1, because with the normal pre-blocked axis I would expect at least an S-wave in V1. Perhaps that is lead positioning, prior posterior MI, or RVH. On a cold read, all of the ST/T-waves appear reasonable. However, you can imagine relative ST-depression in III and ST-elevation in aVL, pointing towards a subtle high lateral infarction. I would not leave that off the list of possibilities, but couch that against the patient’s presentation.