As Figure 1 shows, this patient has long-standing 1° AV block -- dating back to 1949. As shown in the diagram in Figure 2, the impulse from the atrium turns around in the AV junction due to dual AV ...

The diagnosis is NSR, isorhythmic dissociation, acute ST-segment elevation MI (STEMI) of the lateral wall, and poor R-wave progression across the precordium (clockwise rotation). The rhythm is regular ...