Right bundle branch block-induced Q waves simulating anterior myocardial infarction extension.
A concept generally accepted in clinical electrocardiography is the assumption that a right bundle branch block (RBBB) does not alter significantly the initial portion of the QRS complex and because the left bundle branch is intact, the septum is activated normally in a left-to-right direction. We report a woman with an acute anterior myocardial infarction (MI) in which a small R wave was present in leads V1 and V4, but with the development of RBBB associated with PR-interval prolongation, these R waves were replaced by Q waves. Subsequently, the electrocardiographic features of anterior MI disappeared concomitantly with the loss of RBBB. The clinical and electrophysiologic implications of these findings are discussed.
Ortega-Carnicer
J
J
Coronary Care Unit, Hospital Alarcos, Ciudad Real, Spain.
Gómez-Grande
M L
ML
Ambrós
A
A
D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000503:physiopathology; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors