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Case Reports
. 2025 Apr 1;4(2):11-14.
doi: 10.56305/001c.133705. eCollection 2025.

Posterior Occlusive Myocardial Infarction on Chronic Right Bundle Branch Block

Andrew Sanchez  1 , Omar El-Charif  2
Affiliations
Case Reports

Posterior Occlusive Myocardial Infarction on Chronic Right Bundle Branch Block

Andrew Sanchez et al. J Brown Hosp Med. .

Abstract

After experiencing syncope, a woman in her 80s with several cardiovascular risk factors presented to the emergency department with shock. The initial troponin was 3,872 ng/L, and the presenting electrocardiogram (ECG) showed a known right bundle branch block (RBBB), but with ST-segment depressions in V1-V2 out of proportion to the patient's baseline RBBB-related secondary repolarization abnormality. After 3 days of hypotension refractory to antibiotics, left heart catheterization was pursued and demonstrated 100% occlusion of the second obtuse marginal artery, confirming the patient had experienced posterior occlusive myocardial infarction (OMI). This case highlights one ECG pattern consistent with posterior OMI in patients with chronic RBBB.

Keywords: Acute coronary syndrome; Electrocardiography; Occlusive myocardial infarction; STEMI Equivalents.

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Conflict of interest statement

The authors declare they have no conflicts of interest

Figures

Figure 1.
Figure 1.. A, An ECG obtained at presentation showed normal sinus rhythm and 2 to 3 mm ST-segment depressions in leads V1 to V2, and subtle ST-segment elevation in leads II and aVF. B, The baseline ECG demonstrates normal sinus rhythm, left anterior fascicular block, and RBBB with secondary repolarization abnormalities (but no ST-segment depressions) in leads V1 to V2.
Figure 2.
Figure 2.. Right anterior oblique caudal images obtained via coronary angiography on day 3 of hospitalization. A, Red arrow points to 100% occluded 2nd obtuse marginal artery prior to intervention. B, Red arrow after balloon angioplasty shows partial reconstitution of perfusion.
See this image and copyright information in PMC

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