Evidently, this patient has LBBB. The question is whether there is MI or not. Scroll down for the discussion after you have formed your opinion about the issue.

 

 

 

The criteriae derived from the GUSTO I study to diagnose MI in the presence of LBBB are-

  • Discordant ST elevation of 5 mm
  • Concordant ST elevation of 1 mm and
  • Concordant ST depression of 1 mm (applicable only in v1 to v3).

Now take a look at the ECG again and then scroll down.

 

 

 

In the present ECG, v2 shows discordant ST elevation of more than 5 mm and v5 shows concordant ST elevation of 1 mm. Thus there is MI.