case_images: PMC4345245_01
case_images: ECG recorded during the patient's arrival in emergency department showing atrial fibrillation with alternating right and left bundle branch block pattern with ST-T segment changes.
case_images: CRIC2015-895473.001.jpg
case_images: PMC4345245_01_CRIC2015-895473.001.jpg
case_images: fig1
case_images: Among RBBB morphology complexes (as shown in even beats of Figure 1), there was ST-segment elevation in leads V2, V3, I, and aVL with poor R progression in V4-V6. Among LBBB morphology complexes (shown in odd beats of Figure 1), there were significant ST-segment changes in V4 and V5 (concordant leads) as well as ST-segment changes in V2, V3, II, III, and aVF (discordant leads), which fulfilled Sgarbossa criteria and were compatible with a diagnosis of acute myocardial infarction (AMI) (Figure 1).
case_images: ECG after procedure demonstrated atrial fibrillation with complete right bundle branch block without Q wave revealed.
case_images: CRIC2015-895473.002.jpg
case_images: PMC4345245_01_CRIC2015-895473.002.jpg
case_images: fig2
case_images: However, his EKG still showed atrial fibrillation with complete right bundle branch block (Figure 2).
case_images: Angiogram of left coronary artery demonstrating filling defect (white arrow) at the mid portion of LCx (a). After thrombectomy with elimination aspiration catheter, blood flow in LCx was completely restored. The underlying vessel lumen appeared to be normal (b). *LAD-left anterior descending artery, LCX-left circumflex artery, LAO-left anterior oblique, RAO-right anterior oblique, AV-aortic prosthetic valve, and MV-mitral prosthetic valve.
case_images: CRIC2015-895473.003.jpg
case_images: PMC4345245_01_CRIC2015-895473.003.jpg
case_images: fig3
case_images: Ball and cage prosthetic aortic valve and mitral valve appeared to be in a good condition (Figure 3).