Concluded Case

Abnormal ECG

Undiagnosed retrosternal discomfort Chief Complaints Retro sternal discomfort Nausea - 5 days duration History Since last 5 days - patient is having SOB Retrosternal discomfort, Nausea- no chest pain Patient is a known hypertensive on Metoprolol 50 mg O.D Vitals Pulse 80 / minute B.P - 140 / 80 mm of Hg R.R - 20 / minute Temp.36.7 °C Physical Examination Nothing significant Investigations ECG Diagnosis Comments on ECG welcomed

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Concluded answer

Incomplete RBBB with inferior wall mi 2d echo Cardiac markers Loading dose Cardiac opinion

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Incomplete right bundle branch block - lead V1 shows rSr' pattern, QRS complex is only 2 mm duration therefore it is incomplete RBBB LEAD V2 to V6 shows significant ST segment depression with T wave inversion suggestive of ischaemia It need to be treated as anterolateral wall ischaemia

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Flattened T L2and inverted T in all chest leads Rsr v1 Incomplete RBBB with inferior wall ischimia

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RBBB Ant wall ischemia Check S.Troponin level to ruled out NSTEMI

Ischemia. Block

Incomplete RBBB with inferior wall mi 2d echo Cardiac markers Loading dose Cardiac opinion

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