ECG Guru - Instructor Resources

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Old M.I.

Right Bundle Branch Block and Previous Anterior Wall M.I.

Sat, 12/22/2012 - 14:41 -- Dawn

This example of previous anterior wall M.I. with right bundle branch block is from a 90-year-old man.  He survived an anterior-septal M.I. caused by an occlusion of the left anterior descending branch of the LCA. The septum was involved in the damaged area, and the patient was left with a right bundle branch block.  The pathological Q waves in Leads V1 through V3 show the location of permanent damage, or necrosis.

In this case, the usual rSR' pattern of right bundle branch block is replaced by qR, indicating loss of the initial r wave due to the M.I.

Review of RBBB criteria:  wide QRS, rSR' pattern in V1, and Rs with a slurred s wave in I and V6.  These criteria must be present in a SUPRAVENTRICULAR rhythm to diagnose RBBB.

Lateral Ischemia and Previous MI In a Patient With Chest Pain

Mon, 01/09/2012 - 23:48 -- Dawn

This ECG was taken from a 52 year old man who was complaining of chest pain, with a history of severe multi-vessel disease. He has a history of M.I. and states he has five coronary stents.

His pain was partially relieved by Ntg., and he was given aspirin in the field, and then IV Ntg., Integrelin, and morphine before being sent to the cath lab. This ECG shows T wave inversions with coved upward ST segments, but no ST elevation in the lateral leads: I and aVL, and the anterior-lateral leads, V3 through V6. This represents the territory covered by the left coronary artery, and points to a lesion in the proximal portion of the artery. Also in this ECG are pathological Q waves in right side leads, III, V1 and V2.

In the cath lab, he was discovered to have a ruptured plaque in the proximal LAD, with some blood getting through a very narrow channel. He was referred for coronary artery bypass surgery the next day.

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