A 50 yo with chest pain

A 50 yo male presents with chest pain. His ECG is shown below. What does it show?

Rate: 66
Rhythm: Irregularly irregular, not many P waves, so atrial fibrillation.
QRS: Narrow
ST-T: The obvious abnormality here is the STE in II, III and aVF with reciprocal changes in aVL.
There is also some ST depression in V2-V4.

The diagnosis here is an inferior infarction. We need to beware of potential Right Ventricular infarction as well.
How do patients with Right Ventricular Infarction present?
What does the ECG show?
What are the differentials?
What is the management of these patients?
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Isolated right ventricular infarction is rare, but it does occur in 30-50% of cases of inferior infarction. We need to think of the possibility of right ventricular infarction, or we can miss it.
The right ventricle is thin walled and is perfused throughout the cardiac cycle, explaining why it is less likely to infarct.......

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