(Case 4) Left bundle branch block—a 12-lead ECG demonstrated NSR with a LBBB. The ST segment depression in the lateral leads is consistent with the altered conduction pattern in the LBBB patient; no evidence of inappropriate ST segment or T wave morphologies were seen. (Case 4) Left bundle branch block—a 12-lead ECG demonstrated NSR with a LBBB. The ST segment depression in the lateral leads is consistent with the altered conduction pattern in the LBBB patient; no evidence of inappropriate ST segment or T wave morphologies were seen. The LBBB pattern had been noted in the past on a previous ECG. T Pollehn et al. Emerg Med J 2002;19:129-135 Copyright © BMJ Publishing Group Ltd and the College of Emergency Medicine. All rights reserved.