Acute LAD occlusion in the setting of Right Bundle Branch Block and Left Anterior Fascicular Block.
Key features of Right Bundle Branch Block:
In general, there is no ST elevation throughout the 12 Lead ECG.
RBBB has expected slight ST depression, with T wave inversion, in V1-V3 when discordant to a positive R' wave.
A possible normal variant is lateral ST elevation (i.e., I/aVL/V5/V6) with bulky T waves when subsequent to a large, slurred S wave. This finding should be assumed new, until proven otherwise, during suspected Acute Coronary Syndrome.
Combination RBBB/LAFB has a high mortality rate in the setting of LAD occlusion.