Answer for December 2, 2013
The patient has a right bundle branch block (note RsR' in V1, and the slurred s in V6). In the first EKG, r waves are present in III and avF. In the 2nd EKG, Q waves are present. The patient appears to have had an inferior wall infarct (age indeterminate) at some time between the 1st and 2nd EKG's. This reminds us that patterns of infarction usually CAN be read with right bundle branch block. This is because right bundle branch block does not interfere with the normal sequence of activation of the left ventricle.
NOTE: EKG's are for internal educational purposes of the University of Massachusetts Department of Family Medicine. Please do not forward without permission from Dr. Golding!