STAT ECG Diagnoses: any ST segment elevation in patients with right bundle branch blocks (RBBB) is abnormal!

ECG Weekly Workout with Dr. Amal Mattu


HPI:  A 70-year-old male with PMHx of HTN, DM, CKD, and CAD is brought to the emergency department with chest pain and shortness of breath. The following ECG is obtained on arrival and deemed not to meet STEMI criteria. He is hospitalized for ACS evaluation and soon after decompensates and develops cardiogenic shock. He is later found to have left main and LAD occlusions at cath.

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

  1. In patients with suspected acute MI, how does the presence of RBBB effect in-hospital mortality and prognosis?
  2. Do you see any ECG findings on the arrival ECG that are suggestive of occlusion MI?
  3. Would you have managed this case any differently?