This is from a 53 year old male smoker with chest pain.
Here is the initial EKG:
There is grouped beating, in couplets. Both complexes in each couplet are wide. the first complex in each couplet is preceded by a p-wave. If you look at the first of each couplet in V1 and V6, they have RBBB morphology. So this is bigeminy with RBBB. Obviously, the ST and T wave are very abnormal, with huge ST elevation due to LAD occlusion.
In the inferior leads, there appears to be ST elevation in both complexes, but this is not so: what appears to be STE is really just a prolonged QRS.
Thanks to Dave for this case: http://tassieparamedic.blogspot.com/