{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:03:58Z","timestamp":1785420238411,"version":"3.56.0"},"reference-count":6,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>After experiencing syncope, a woman in her 80s with several cardiovascular risk factors presented to the emergency department with shock. The initial troponin was 3,872 ng\/L, and the presenting electrocardiogram (ECG) showed a known right bundle branch block (RBBB), but with ST-segment depressions in V1-V2 out of proportion to the patient\u2019s baseline RBBB-related secondary repolarization abnormality. After 3 days of hypotension refractory to antibiotics, left heart catheterization was pursued and demonstrated 100% occlusion of the second obtuse marginal artery, confirming the patient had experienced posterior occlusive myocardial infarction (OMI). This case highlights one ECG pattern consistent with posterior OMI in patients with chronic RBBB.<\/jats:p>","DOI":"10.56305\/001c.133705","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T07:50:23Z","timestamp":1743493823000},"source":"Crossref","is-referenced-by-count":1,"title":["Posterior Occlusive Myocardial Infarction on Chronic Right Bundle Branch Block"],"prefix":"10.56305","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6910-5554","authenticated-orcid":true,"given":"Andrew","family":"Sanchez","sequence":"first","affiliation":[{"name":"Harvard Medical School, Beth Israel Deaconess Medical Center","department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0425-4385","authenticated-orcid":false,"given":"Omar","family":"El-Charif","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05tszed37","id-type":"ROR","asserted-by":"publisher"}],"name":"Yale New Haven Hospital","department":["Section of Cardiovascular Medicine, Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"issue":"23","key":"ref1","doi-asserted-by":"publisher","first-page":"e022866","DOI":"10.1161\/JAHA.121.022866","article-title":"Ischemic ST-Segment Depression Maximal in V1\u2013V4 (Versus V5\u2013V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)","volume":"10","author":"H. 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