Male patient in 80s, chest discomfort more than 8 hours in duration, negative troponin, previous notes have documented a bifascicular block. Chest x-ray shows infection, labs raised inflammatory markers, PR interval is about 240, there is a RBBB. You would expect T wave inversions in early chest leads in RBBB, but would the position of J point in the more tachycardic ekg alarm you? Or would you call it ‘rate-related’ ischemic change?

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Rate related ISCHEMIC changes . Tall R in V1,2 ,3 is seen . Should we think of true posterior wall ischemia/ infarct as cause of his chest discomfort? Will V7,8,9 and right ventricular leads give more information?
RBBB C ARETHEMIA he needs class III anti arehth Amiodarone will suit better to have openion of Arrethemia specialist openion
Tachycardia RBBB S1q3t3 pattern Persistent S in V6... acute rt heart STRAIN?(raising suspicion of PE until proven otherwise?)
bifafasicular progress to Rbbb alarming
Atrial. Flatter