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Myocardial Infarction + LBBB


Step 1: View clinicals

A 70 year old man presents with acute, severe retrosternal pain radiating to the left shoulder and arm for 1 hour. His medical history is only significant for hypertension for 5 years, which is well controlled on ramipril alone. There is no history of diabetes, dyslipidemia or ischemic heart disease. He does not smoke, and is not on any drugs.

Step 2: Order all relevant investigations


The ECG reveals the presence of left bundle branch block (LBBB); there is ST-segment elevation of 2 mm in leads V1-V3, along with concordance of the QRS complexes, T waves and ST segments.

Cardiac Troponins

Troponin-I: 0.1 ng/ml (normal: < 0.1)

Chest X-Ray

The chest x-ray appears completely normal.


The echocardiogram reveals the presence of concentric left ventricular hypertrophy, along with focal hypokinesia of the anterior and lateral walls.

Step 3: Select appropriate management

Primary PCI
NG Tube
Aortic Surgery

Score: ★★☆