There's STE in V1 !

EMS responds to the report of a 77 year old male with chest pain. The patient is hypertensive, alert, and hemodynamically stable. Aspirin and nitroglycerin are administered per treatment protocol. A 12 lead ECG is obtained, and the paramedic asks about transport to the closest hospital versus a facility capable of percutaneous coronary intervention...


12 lead ECG



12 lead ECG Discussion

There is a baseline sinus rhythm. The rhythm is regular. Close scrutiny of lead II and V1 reveals the presence of p waves. The ST segments are upright in most leads with the exception of aVR. The QRS duration is slightly prolonged consistent with an interventricular conduction delay. The (1) positively deflected QRS in lead V1 and the (2) lengthened QRS duration suggests the presence of a RIGHT bundle branch block. There is a subtle slurred l S wave in V6 which further corroborates the diagnosis of a right bundle branch block.

The Slurred S Wave

12 lead ECG Interpretation

Sinus rhythm, right bundle branch block, rate of approx 80 beats/min.

Case resolution

The patient was transported to a local facility. Serial ECGs remained unchanged and cardiac enzymes were normal. The patient was discharged to home following an overnight hospital stay and a cardiac stress test.