Transient right axis deviation with left posterior hemiblock and junctional rhythm during acute myocardial infarction

One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. Changing Axis Deviation has been reported during acute myocardial infarction also associated with atrial fibrillation. Isolated left posterior hemiblock is a very rare finding but the evidence of transient right axis deviation with a left posterior hemiblock pattern has been reported during acute anterior myocardial infarction as related with significant right coronary artery obstruction and collateral circulation between the left coronary system and the posterior descending artery. We present a case of transient changing axis deviation, transient right axis deviation, transient left posterior hemiblock pattern and transient junctional rhythm too in a 61-year-old Italian man with acute myocardial infarction and a significant left anterior descending coronary artery stenosis.