This ECG shows a patient with atrial fibrillation, left axis deviation, absent P waves, widened QRS complex with RBBB pattern, ST elevation in leads V1-V4 consistent with anterior wall myocardial infarction. There is also secondary R wave slurring and widening in V1-V4 and widened terminal S waves in V5-V6. The diagnosis is acute anterior wall myocardial infarction with bifascicular block (RBBB with left anterior fascicular block). The prognosis is poor, as myocardial infarction with bifascicular block can increase mortality by 4-5 times.

1. ECG OF THE WEEKPROF.S.SUNDAR UNIT

3. ECG FINDINGRATE 150/MINRHYTHM AF/IRREGULARLY IRREGULARAXIS -80⁰/LEFT AXIS DEVIATIONP WAVE ABSENTQRS COMPLEX Q WAVE V1-V4 SECONDARY R WAVE WITH SLURRING,WIDENING V1-V4 WIDENED TERMINAL S WAVE V5,6 S/O AWMI WITH RBBBrS pattern in II,III and aVF s/o LAFB A SINGLE VENTRICULAR ECTOPIC IS SEENST SEGMENT Elevation v1-v4 s/o ACUTE AWMIT WAVE SYMMETRICAL, DEEP INVERSION V1 -V4 S/O PRIMARY CHANGES

5. DIAGNOSISACUTE ANTERIOR WALL MYOCARDIAL INFARCTION WITH BI-FASCICULAR BLOCK(RBBB WITH LAFB)ATRIAL FIBRILLATION

6. MI WITH BLOCKLBBB MAY BE MISINTERPRETED AS RECENT ANTROSEPTAL MIMI MAY BE MASKED BY PRESENCE OF LBBBRBBB NEITHER MIMICS NOT MASKS MOST MI

7. MI WITH RBBBRBBB AFFECTS MID AND TERMINAL PORTIONAL OF QRS COMPLEXSINGLE EXCEPTION- POSTERIOR BASAL MI WHICH AFFECT TERMINALPART QRS AND MASKED BY RBBB

8. RBBB WITH ANTERIORWALL MIR WAVE DISAPPEAR IN V1-V4 AND REPLACED BY QWAVE DUE TO INVOLMENT OF ANTERIORWALL OF RVSECONDARY R WAVE PERSIST DUE TO DELAYED ACTIVATION OF UNINVOLVED FREEWALL OF RV

9. RBBB WITH INFERIORWALL MIMINIMAL INFLUENCE ON THE ANTERIORWALL LEADS QWAVE AND ST SEGMENT CHANGES IN INFERIORWALL LEADS ALONG WITH RBBB PATTERN IN PRECARDIAL LEADS

10. PROGNOSISMI WITH LAFB – MINIMAL ADVERSE EFFECT ON PROGNOSIS MI WITH LAFB WITH RBBB – POOR PROGNOSIS MORTALITY 4-5TIMES INCREASEDMI WITH LPFB WITH RBBB – POOR PROGNOSIS MORTALITY 6-7 TIMES INCREASED10 MI WILL DEVELOP BIFSCICULAR BLOCK

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