Anterior ST elevation in a patient with RBBB

A 79-year-old male with a history of coronary artery disease presented to the Emergency Department with chest pain. ECG showed RBBB with mild ST elevation and positive T waves in I, aVL and V2. In patients with RBBB lack of ST depression and T wave inversion in the anterior leads could signify ischemia secondary to left anterior descending coronary artery occlusion. However, the patient did not have acute coronary syndrome and the presenting ECG was comparable to an ECG recorded five years earlier.