Atypical ischemic repolarization in right bundle branch block.

A 70-year-old male presented to emergency room 16 h after the onset of acute chest pain. Initial ECG showed sinus rhythm with a wide QRS and right bundle branch block (RBBB) with concordant and symmetric T waves in V1-V2. A plausible explanation for the atypical positive T waves in leads V1-V2 in conjunction with RBBB could be non-reperfused lateral MI (LMI) as a "mirror-image" of inverted T waves in the posterior leads V7-V9. Coronary angiography showed total thrombotic occlusion TIMI thrombus grade 5 of the circumflex artery. One ECG expression of circumflex artery occlusion is isolated LMI.