A 75 year old man sought medical attention from his internist because of a several week period of decreased exercise tolerance.EkGshowed sinus tachycardia,left axis deviation and a left bundle branch block (LBBB) that fulfilled the Strauss criteria for LBBB diagnosis.
Two days later the patient was seen by a cardiologist and an EKG done that day showed a non specific intraventricular conduction defect with right axis and clearly did not meet the criteria for LBBB. In the interim between the two EKGS there was no change in the patient's clinical status.
Two weeks later EKGs done as part of an echo exercise stress tests again showed classic EKG with Straus criteria.
What could explain the changes in EKG pattern?
A change from left axis deviation to right axis could be due to a pulmonary embolus but there were no new pulmonary symptoms and no history of physical findings of DVT.
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