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Right Bundle Branch Block with ST Elevation in V1?

Posted Feb 02 2013 8:57am

There is a wide QRS with a tall R-wave in aVR and V1 and wide S-wave in lateral leads, leading one to believe this is RBBB.  There is ST elevation in V1, and ST depression in V4-V6, suggestive of ischemia/MI.   What is the Diagnosis? --see Below

This is a classic pseudoinfarction pattern -- hyperkalemia, with K of 6.9 due to DKA (pH 7.12, bicarb 6).  In this case the diagnosis was easy because the patient presented very ill with known Type I diabetes and with vomiting, not chest pain.

However, here are two from my files that presented with chest pain:

The peaked T-waves give it away, but the ST elevation in V1 and V2 is a little known pseudoinfarction pattern.  There was no MI here.

Thanks to K. Wang for this EKG.  Again, there was no MI, only hyperkalemia.

In all 3 of these cases, the findings disappeared with treatment of hyperkalemia, and the ECG normalized.
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