This 29-year-old woman with Marfan’s syndrome is in the cardiac surgical intensive care unit 2 days after Bentall procedure (replacement of the aortic valve, aortic root and ascending aorta):

• Sinus rhythm with 2:1 second degree AV block and junctional escape complexes (escape-capture bigeminy)
  
• Ventricular rate 84/min
  
• Right bundle branch block
  
• ST and T wave abnormality (probably secondary to RBBB)