Repost: Syncope, Shock, AV block, RBBB, Large RV, " Anterior " ST Elevation in V1-V3

I came across this post from 2015 while answering a question on Twitter, and decided to repost it:http://hqmeded-ecg.blogspot.com/2015/12/syncope-shock-av-block-large-rv.htmlSyncope, Shock, AV block, RBBB, Large RV, " Anterior " ST Elevation in V1-V3An elderly male had a syncopal episode. 911 was called. When medics arrived, the patient was alert and following commands. In the presence of the medics, he lost consciousness and became apneic and underwent 30 seconds of chest compressions, after which he started moaning and was again able to communicate and follow commands.  No shock was ever delivered.A 12-lead was recorded:Without a rhythm strip, this rhythm is difficult. In any case, there is bradycardia. There is either RBBB (see rSR ' in V1) or there is a left sided escape rhythm that gives RBBB morphology.There is ST depression beyond the end of the wide QRS in I, II, aVF, and V4-V6, diagnostic of with subendocardial ischemia. There is no ST elevation.The patient was moaning upon arrival to the ED, looked ashen, and had agonal respirations. He was unresponsive to painful stimuli.He was in profound shock.He was intubated.A bedside cardiac ultrasound was recorded:If this video does not work, you can view it here: https://vimeo.com/148133345Here is a still image of the echo:Thered arrows outline the right ventricle and theyellow arrows outline the left ventricle chamber.What do you think?There is no pericardial fluid to account for...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs