MI Diagnosis in RBBB

As shown in the examples below, myocardial infarction diagnosis in right bundle branch block is not very different from normal MI diagnosis. As repolarisation in leads V1-V3 is often abnormal in RBBB, these leads cannot always be used for the diagnosis of ischemia.

Examples

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  Case 1a: Patient with RBBB and inferior MI. Notice left axis deviation.

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  Case 1b: Lead V4R in the same patient with RBBB and inferior MI clearly shows ST elevation.

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  Case 1c: The same patient before acute MI developed. Horizontal axis.

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  Case 2a: RBBB with anterior myocardial infarction. ST elevation in V2-V3.

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  Case 2b: ECG from the same patient before the MI occured.