McGill Case 277

This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia. Previous Case: McGill Case 276 | Next Case: McGill Case 278

The rhythm is sinus and there is first degree A/V block (>200ms). There is terminal P wave negativity in V1 suggestive of left atrial abnormality. There is left anterior fasicular block (axis < -30 degrees). The ST segment is slightly elevated in leads II and aVF with T wave inversion suggesting inferior ischemia or infarctions.