RBBB. Is there ST Elevation in III and aVR, with reciprocal ST depression in I and aVL?

I received this ECG from someone who wishes to remain anonymous.Case" Last night we had a Stage 4 Lymphoma Cancer Patient presenting with this ECG above. Wife advised that he just woke up from a nap and was being assisted on a walk when he became dizzy and had a syncopal episode. Patient was A&O when EMS arrived. Patient seemed confused. Patient had shortness of breath when EMS got to him. Initial vitals as follows: "" Patient was cool to touch and dry, Lung sounds clear. "BP: 141/70HR: 139RR: 31SpO2: 79%ETCO2: 18" Patient denied any other complaint other than SOB. SpO2 improved to 97% on 15lpm on a non rebreather. " " The ECG notes sinus Tach with RBBB and LPFB. What was throwing me off was the ST Elevation in aVR and lead III with the depression in the lateral leads. Is this rate related or possible occlusion? " What do you think?I read this on my phone and responded:" This is a classic fake-out. "" All of what appears to be ST elevation and ST depression is really part of the QRS, which is very wide. "" Take another close look. "" This is probably a pulmonary embolism. "Had I not been on the run and looking on my phone, I would have said: " This is almost certainly a pulmonary embolism. "Further comment:Clinical: In a cancer patient with sudden SOB with clear lungs, low saturations, increased respiratory rate, sinus tachycardia, and low end tidal CO2, the top 3 diagnoses on the differential are pulmonary embolism.ECG: There is sinus tachycardia at a rate of 1...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs