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  • Title: Right bundle branch block-induced Q waves simulating anterior myocardial infarction extension.
    Author: Ortega-Carnicer J, Gómez-Grande ML, Ambrós A.
    Journal: J Electrocardiol; 2000 Oct; 33(4):387-91. PubMed ID: 11099364.
    Abstract:
    A concept generally accepted in clinical electrocardiography is the assumption that a right bundle branch block (RBBB) does not alter significantly the initial portion of the QRS complex and because the left bundle branch is intact, the septum is activated normally in a left-to-right direction. We report a woman with an acute anterior myocardial infarction (MI) in which a small R wave was present in leads V1 and V4, but with the development of RBBB associated with PR-interval prolongation, these R waves were replaced by Q waves. Subsequently, the electrocardiographic features of anterior MI disappeared concomitantly with the loss of RBBB. The clinical and electrophysiologic implications of these findings are discussed.
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