Differential Diagnoses: findings of occlusion MI in patients with right bundle branch block (RBBB), prolonged QT intervals, and so much more!

ECG Weekly Workout with Dr. Amal Mattu


HPI

A 64-year-old man with history of pulmonary embolism (on apixaban) presents to the ED with shortness of breath and lower extremity edema. He also reports mild headache and is noted to be somewhat somnolent. No focal neurological deficits are present and the rest of his exam is unremarkable. The following ECG is obtained:

Before watching the video, look closely at this ECG and ask yourself:

  1. What is your differential for T wave inversions?
  2. What is your differential for long QTc intervals?
  3. What imaging study would you obtain in this patient and what is the most likely diagnosis?