Anterior Infarction and Rate-Dependent LBBB

Report:

Sinus rhythm 66/min

SVEBs, blocked

Rate-dependent left bundle branch block

Anterior infarction ?age

Comment:

The pauses created by the non-conducted SVEBs are long, but still not fully compensatory. The complexes terminating the pauses are normally conducted, but provide relatively little information about the infarct. The diagnosis rests with symmetrically inverted T waves in V2-4 – a primary T wave change in LBBB conduction.

The primary T wave changes persisted over several days (43a). One could not state for sure that they were infarctional, being markers of any myocardial (as opposed to “pure” conduction system) disease. The clinical context, however, left no room for doubt.

43a.

44. 74 year old man with history of myocardial infarction.

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