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You are working with a missionary medical team in an outpatient clinic in Northeast Thailand. The 51-year-old male below presents with complaints of recurring syncopal episodes. Your interpretation/recommendation would be: (choose only one)...
A. Acute anteroseptal MI. This is especially evident in Lead V3. Magnify this lead and look carefully at the ST segment (elevated and concave down) and the biphasic T-wave.
B. ST elevation (plateauing) in Lead avR is virtually diagnostic of the acute ST-elevation MI (right ventricle).
C. Atypical RBBB. Magnify Lead I and note the small terminal S-wave. This tracing meets the Triad: 1. QRS duration > or = 0.12 sec 2. Lead I is biphasic with terminal S-wave 3. Leads V1, V2 and V3 with RSR' (slur or notch).
D. Wolff-Parkinson-White syndrome (WPW). The peculiar shape of the ST segment in Leads V1, V2 and V3 are probably related to the retrograde propagation through the accessory pathway (Bundle of Kent).
E. Lown-Ganong-Levine Syndrome (LGL). The peculiar shape of the ST segment in Leads V1, V2 and V3 are probably related to the retrograde propagation through the accessory pathway.
F. The Brugada Syndrome. Characterized by the peculiar shape and elevation of the ST-segments of Leads V1, V2 and V3 (note angle of nearly 45 degrees) and T-wave inversion.
G. Atypical Left Anterior Fascicular Block (LAFB). The electrical axis is -75 degrees. This tracing meets the triad of 1. Axis < -45 degrees 2. Small Q's Leads I and avL 3. Small R's Leads II, III and avF.
H. Non-specific IntraVentricular Conduction Delay (IVCD). The tracing does not satisfy the criteria of any known pattern.
I. Lead misplacement. Leads V1, V2 and V3 have been placed one intercostal space lower than the standard. This placement will usually give ST elevation and T-wave inversion similar to this tracing.
J. None of the Above.