Abstract
References
- 1. Jeremy S. Treger, Ahmad B. Allaw, Pouyan Razminia, A Revised Definition of Left Bundle Branch Block Using Time to Notch in Lead I. JAMA Cardiol. 2024;9(5):449-456. doi:10.1001/jamacardio.2024.0265
- 2. Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med 1996;334:481-7.
- 3. Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Ann Emerg Med 2012;60:766-76
- 4. Andrea Di Marco,Marcos Rodriguez,Juan Cinca et al. New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block. J Am Heart Assoc. 2020;9:e015573.
Electrocardiographic Criteria for the Diagnosis of Acute Myocardial Infarction in Patients with Left Bundle Branch Block
Abstract
During normal conduction system, the first segment depolarized is interventricular septum, normal ventricular depolarization begins with the septal fascicle of the left bundle branch followed by a simultaneous depolarization of the remaining ventricular walls from endocardium to pericardium via the right and left bundle branches. In left bundle branch block (LBBB) condition, the left ventricular activation is delayed, and the initial septal activation is from right to left, secondary ST segment and T wave abnormalities occur, and septal Q waves indicative of an MI are absent. About 0.5 percent of patients with acute myocardial infarction had left bundle-branch block
Patients with left bundle branch block (LBBB) and suspected of acute myocardial infarction (MI) is challenge to the clinician. A diagnosis of MI with electrocardiogram (ECG) is especially difficult in the setting of LBBB because of the characteristic ECG changes caused by altered septal and left free wall ventricular depolarization. Here we review the pathophysiology of LBBB in MI, highlight evolving paradigms for the diagnosis of suspected MI in patients with LBBB.
References
- 1. Jeremy S. Treger, Ahmad B. Allaw, Pouyan Razminia, A Revised Definition of Left Bundle Branch Block Using Time to Notch in Lead I. JAMA Cardiol. 2024;9(5):449-456. doi:10.1001/jamacardio.2024.0265
- 2. Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med 1996;334:481-7.
- 3. Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Ann Emerg Med 2012;60:766-76
- 4. Andrea Di Marco,Marcos Rodriguez,Juan Cinca et al. New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block. J Am Heart Assoc. 2020;9:e015573.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Letter to the Editor |
| Authors | |
| Publication Date | September 5, 2024 |
| Submission Date | April 30, 2024 |
| Acceptance Date | September 2, 2024 |
| Published in Issue | Year 2024 |
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Indexing and Abstracting