case_images: PMC6365986_01
case_images: Electrocardiogram (ECG) appears to show an elevation of the ST segments in leads III and aVF (arrows) and a reciprocal depression of the segments in the precordial leads (V2-5) (arrow heads). It actually shows typical findings of right bundle branch block (RBBB), including a widening of QRS, rSR' patterns in precordial leads (V1-3) and slurred S waves in the lateral leads (I, aVL, V5-6).
case_images: 10.1177_2050313X19827748-fig1.jpg
case_images: PMC6365986_01_10.1177_2050313X19827748-fig1.jpg
case_images: fig1-2050313X19827748
case_images: III and aVF (Figure 1, arrows) and a reciprocal depression of the segments in precordial leads (V2-5) (Figure 1, arrowheads). In addition, chest computed tomography (CT) scanning, which ruled out the possibility of acute aortic dissection, revealed a calcification in the right coronary artery. Since the patient's ECG originally showed typical findings of RBBB, including a widening of QRS, the rSR' patterns in precordial leads (V1-3), and the slurred S waves in the lateral leads (I, aVL, V5-6) (Figure 1), the apparent ST segment elevation in leads III and aVF was considered to be the end of QRS in this widened RBBB (Figure 1, arrows). Likewise, the apparent reciprocal changes observed in V2-5 were actually the S-wave, not the depression of the ST segment (Figure 1, arrowheads).