McGill Case 277

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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.

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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.