LAD: Inferior MI + LAHB

Report:

Atrial tachycardia approx. 150/min with block (PAT with block)

Right bundle branch block

Left anterior hemiblock

Old inferior infarction

Small voltage

Comment:

Typically, V1 is the only lead with easily discerned atrial waves in PAT with block. They are in fact large and peaked enough to distort the RBBB QRS complex where the two overlap. Long Wenckebach periods are shown on the next two strips (Fig 74a), with only one clearly visible P wave in each.

The patient recovered with potassium supplements and stopping digoxin.

The patient had a known inferior MI in the past, but some features of LAHB are also present: a ‘ledge’ at the QRS onset in lead 2, lack of secondary R waves in all three inferior leads and its presence in aVR; RS in V6.

Fig 74a.

Fig 75. 60 year old man with hypertensive/ischæmic heart disease.

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Ventricular Conduction

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