A 65 yo with h/o HTN, CAD, S/P CABG c/o chest pain.
Figure 1 - ECG case
This is sinus bradycardia with right bundle branch block (RBBB) pattern in the precordial leads (predominant R waves in V1). However, the T waves are upright in V2 and V3 and not as inverted in V1. Typical RBBB pattern had T waves that are opposite in direction to the R waves.
Cardiac catheterization was done. It revealed a depressed LV systolic function (EF ~ 30%) with patent vein grafts to the right coronary artery and left anterior descending artery. Revascularization of the native AV groove circumflex artery with stent.
Figure 2 - post- cardiac catheterization ECG
The ECG showed sinus rhythm with RBBB pattern but now the T waves are inverted in V1-V3.
So, this case is RBBB in the setting of a circumflex artery lesion.