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Masquerading bundle branch block (MBBB) is a rare presentation of bifascicular blocks. It is the result of a right bundle branch block associated with an advanced left anterior fascicular block due to extensive damage to the conduction system. We present the case of a 75-year-old male with late onset presentation anterior wall myocardial infarction (MI) with ongoing ischemia (which evolved into a ventricular septal defect [VSD]).

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