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Patient
79-year-old man with no prior history, hospitalized for typical chest pain during five hours;
Trace
Sinus rhythm, normal PR interval; complete right bundle branch block (QRS duration 120 ms, QR pattern in V1, delayed intrinsicoid deflection in V1, wide S wave in V6); wide and deep Q-wave from V1 to V3; elevation from V2 to V5;
Trace
The coronary angiogram revealed thrombosis of the proximal LAD treated by angioplasty + stenting; ECG recorded 2 days later; intermittent right bundle branch block (1 complex with narrower QRS); identical repolarization pattern (elevation from V2 to V4) whether the QRS is wide or narrow;
Trace
ECG recorded 2 hours later; QRS narrowing (disappearance of the right bundle branch block pattern);
Exergue
The onset of a right bundle branch block in the course of an acute anterior coronary syndrome reflects the presence of a proximal LAD lesion and alters the prognosis to at least the same extent as the onset of a left bundle branch block.
The occurrence of a right bundle branch block is mainly observed in anterior infarctions by occlusion of the proximal LAD before the first septal branch which supplies the right bundle branch.