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Patient
64-year-old man followed for hypertension treated by beta-blocker; right bundle branch block on a reference ECG; hospitalization for chest pain at H + 2;
Trace
Sinus rhythm, normal PR interval; complete right bundle branch block (QRS duration 120 ms, RsR' pattern in V1, wide S wave in V6); elevation from V2 to V5;
Trace
The coronary angiogram revealed a thrombosis of the mid-LAD treated with angioplasty + stenting; tracing recorded 2 days after angioplasty; minimal Q-waves from V3 to V6; inverted T-waves from V3 to V6 and in the inferior leads; negative, deep and symmetrical T-waves from V3 to V5;
Exergue
The presence of a right bundle branch block incurs little or no interference with the diagnosis of coronary syndrome both in the acute or chronic stages. A few cases of false negative in instances of anteroseptal infarction have been described.
A right bundle branch block schematically corresponds to a normal activation of the left ventricle and a delayed activation of the right ventricle. The electrocardiogram thus reveals a wide QRS, a delayed intrinsicoid deflection in V1 with a delayed R' wave and a wide and slurred S wave in V6.