The American Heart Hospital Journal
consistent with a lateral wall myocardial infarction as is the right axis deviation. Lead V1 is classic for right bundle branch block, which in the absence of congenital heart disease rarely has a right axis orientation (in right bundle branch block the QRS axis is determined by the first 80 ms of the QRS). The change from lead V5 to lead V6 is also suggestive of lateral infarct (although in the presence of right axis deviation, the position of lead V6 posterior
ECG Clinic
to the other chest leads makes this only suggestive). The P waves are bifid, consistent with interatrial block (IAB) and the points of the P waves are more than 40 ms separated in leads V5 and V5; with the large negative component of the biphasic P wave in lead V1 (Ptf), this is consistent with left atrial enlargement (frequent with IAB). Lead III shows minimal ST-T changes, which is frequent with acute pericarditis. n
Winter 2011
Acute Pericarditis Superimposed on Right Bundle Branch Block, Posterior Fascicular Block, and Interatrial Block
113
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