**Question:** The following ECG with ST elevation on VI V2 is associated with the diagnosis of

A. Anterior Wall Myocardial Infarction
B. Right Bundle Branch Block
C. Right Ventricular Infarction
D. Brugada Syndrome

**Core Concept:** ST elevation on ECG in leads II, III, aVF, and V1-V6 is typically associated with Right Bundle Branch Block (RBBB). However, ST elevation in lead V2 alone can indicate various conditions.

**Why the Correct Answer is Right:** In this case, ST elevation in lead V2 is suggestive of Right Ventricular Infarction (RVI), which is a specific type of myocardial infarction involving the right ventricle. This pattern is distinct from anterior wall MI, which is associated with ST elevation in leads V1 and V2, as well as reciprocal ST depression in leads I, aVL, and V5-6. RBBB would cause ST elevation in leads II, III, aVF, and V1-V6 but not in V2 alone. Differences between RBBB and RVI are important to differentiate to avoid misdiagnosis and improper treatment.

**Why Each Wrong Option is Incorrect:**

A. Anterior Wall Myocardial Infarction: The ST elevation in leads V1 and V2 along with reciprocal ST depression in leads I, aVL, and V5-6 is distinct from the given ECG pattern.

B. Right Bundle Branch Block: ST elevation in leads II, III, aVF, and V1-V6 is absent in this case, distinguishing it from RBBB.

C. Brugada Syndrome: Although right ventricular leads show ST elevation in Brugada Syndrome, there is no ST elevation in lead V2, which is present in the given ECG pattern.

D. Brugada Syndrome: As explained above, right ventricular leads show ST elevation in Brugada Syndrome, but the ST elevation in lead V2 is absent in this case.

**Clinical Pearl:** ST elevation in lead V2 (and V1) is pathognomonic for Right Ventricular Infarction, while ST elevation in leads II, III, and aVF is pathognomonic of Right Bundle Branch Block. Understanding these differences enables accurate diagnosis and appropriate treatment.

**Correct Answer:** C. Right Ventricular Infarction

This question tests your ability to recognize ECG patterns associated with specific cardiac conditions and differentiate them based on the ECG characteristics. Understanding these distinctions is crucial for accurate diagnosis and appropriate management of patients presenting with chest pain and ST-elevation ECG changes.