This ECG was obtained from a patient who suffered an occlusion of the left main coronary artery. ST elevation is seen in Leads V1 through V6, as well as I and aVL. This is an indicator that the circumflex artery is included in this M.I., and the occlusion is above the bifurcation of the LM and the circ. The patient also has a right bundle branch block and a left posterior fascicular block.
Left posterior fascicular block
This is a good clear example of right bundle branch block with left posterior fascicular block. The RBBB is diagnosed by the following criteria: wide QRS (.12 sec), supraventricular rhythm (NSR), an rsR' pattern in V1, and wide little s waves in I and V6. The LPFB is inferred by the right axis deviation (Lead III QRS is a bit taller than Lead II and Leads I and aVL are negative), and the fact that there is no other obvious cause for right axis shift noted in this patient. This constitutes a BIFASCICULAR BLOCK.
This is a good example of acute anterior wall M.I., with ST elevation in V1 through V6, as well as in Leads I and aVL. The extensive distribution of ST segment elevations across the anterior and high lateral walls indicates a proximal LAD artery occlusion. In addition, this ECG shows right bundle branch block, with a QRS width of 144 ms (.14 sec.) and an rsR' pattern in V1.
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