Electrocardiographic signs of acute myocardial infarction in left bundle branch block

Ivanov, Igor; Bugarski, Sonja; Dejanovic, Jadranka; Stojsic-Milosavljevic, Anastazija; Radisic-Bosic, J; Vujin, Bojan

doi:10.2298/mpns1312503i

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…characteristic increase of cardiospecific enzymes. It should be emphasized that ECG changes can be uncharacteristic (complete left bundle branch block, changes in avR lead), making the diagnosis even more difficult [5,8].…”

Section: Discussionmentioning

confidence: 99%

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Posterior wall myocardial infarction: A case report

et al. 2017

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Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1?V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1?V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy.

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Section: Discussionmentioning

confidence: 99%

“…Equivalents to ST elevation myocardial infarction represent a great diagnostic problem. They are: ST segment elevation in aVR lead indicating left main coronary artery stenosis, the left bundle branch block in myocardial infarction, and posterior myocardial infarction [5,6]. In Summary Introduction.…”

Section: Introductionmentioning

confidence: 99%

Posterior wall myocardial infarction: A case report

et al. 2017

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“…ST segment criteria for the diagnosis of acute ischemia are affected by the presence of the left bundle branch block, because of the presented secondary ST changes that occur in this pattern. Left bundle branch block presents a dilemma in the evaluation of chest pain [34]. ECG diagnosis of MI in this pattern is difficult, but possible.…”

Section: New or Presumed New Left Bundle Branch Blockmentioning

confidence: 99%

Atypical electrocardiographic presentations of myocardial infarction with ST elevation - ST elevation myocardial infarction equivalents

Dejanovic

Stojsic-Milosavljevic

Trajković

et al. 2018

Med pregl

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Introduction. Some patients with clinical symptoms and signs of acute myocardial and coronary artery occlusion have atypical electrocardiographic presentations-ST elevation myocardial infarction equivalents. Rapid recognition of these patterns is imperative, because the condition requires prompt reperfusion therapy following actual guidelines. De Winter pattern. Diagnostic criteria are: tall, prominent, symmetrical T-waves in the precordial leads, upsloping ST segment depression > 1 mm at the J-point in the precordial leads, absence of ST elevation in the precordial leads, ST segment elevation (0.5 mm-1 mm) in aVR. ST Elevation in aVR. Electrocardiographic criteria include ST segment elevation in aVR ≥ 1 mm, ST segment elevation in aVR ≥ V1, and diffuse ST segment depression in lateral leads. Wellens syndrome. Wellens syndrome describes deeply inverted or biphasic T-waves in leads V2-V3, highly specific for significant stenosis of the left anterior descending artery. Posterior infarction. Posterior infarction is confirmed with ST segment depression ≥ 0,5 mm in leads V1-3 and ST segment elevation ≥ 0.5 mm in posterior leads (V7-V9). Conclusion. There are many electrocardiographic patterns that physicians should promptly recognize as clinical myocardial infarction with ST segment elevation equivalents in order to perform urgent reperfusion therapy for better prognosis and survival in these patients.

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“…It should be emphasized that nonspecific ECG changes, such as complete left bundle branch block and changes in avR lead, make the diagnosis of MI more difficult [6,7]. A great diagnostic problem are some ECG patterns called ST elevation myocardial infarction equivalents.…”

Section: Introductionmentioning

confidence: 99%

“…A great diagnostic problem are some ECG patterns called ST elevation myocardial infarction equivalents. They are: ST segment elevation in aVR lead indicating left main coronary artery stenosis, the left main coronary artery stenosis, the left bundle branch block in myocardial infarction, and posterior myocardial infarction [6][7][8]. In some cases, chest pain along with the signs of ischemia on ECG and cardiac enzymes may be caused by conditions other than coronary, like in myopericarditis [9].…”

Section: Introductionmentioning

confidence: 99%

ST elevation myocardial infarction equivalent - De Winter T-wave electrocardiography pattern

Ivanov

Stojsic-Milosavljevic

Ivanović

et al. 2018

Med pregl

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Introduction. Rapid diagnosis of acute myocardial infarction is essential for proper treatment and reduction of patient mortality. Electrocardiography plays an important role in its diagnosis. Acute myocardial infarction with ST segment elevation requires urgent reperfusion therapy, that is, primary percutaneous coronary revascularization. A small number of patients with acute myocardial infarction have ST segment depression in one or more leads, whereas ST segment elevation in augmented vector right the electrocardiogram is characteristic for a myocardial infarction without ST elevation, but the clinical course and the severity of disease correspond to the anterior myocardial infarction with ST segment elevation. De Winter T-wave electrocardiography. One of these forms is known as de Winter T-wave pattern, characterized by ST segment depression at the J-point (> 1 mm) in the precordial leads, the absence of ST segment elevation in the precordial leads, high peaked and symmetrical T-waves in the precordial leads and, in most cases, mild ST segment elevation (0.5 mm to 1 mm) in the augmented vector right. These patients have occlusion of the left main coronary artery, occlusion of the proximal segment of the anterior descending artery, or a severe multivessel coronary disease. Patients with this electrocardiographic pattern, which is equivalent to acute myocardial infarction with ST segment elevation, require consideration of emergency reperfusion therapy due to high mortality, compared to other patients with acute myocardial infarction without ST elevation. Primary percutaneous intervention is recommended, or if there is no catheterization laboratory nearby, fibrinolytic therapy may be considered. Because of the lack of clear recommendations, treatment decisions are made individually, from case to case. Conclusion. We need large prospective studies with this specific electrocardiographic pattern to provide quick recognition and proper treatment of the anterior myocardial infarction with ST elevation.

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Electrocardiographic signs of acute myocardial infarction in left bundle branch block

Abstract: The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.

Cited by 4 publications

References 14 publications

Posterior wall myocardial infarction: A case report

Posterior wall myocardial infarction: A case report

Atypical electrocardiographic presentations of myocardial infarction with ST elevation - ST elevation myocardial infarction equivalents

ST elevation myocardial infarction equivalent - De Winter T-wave electrocardiography pattern

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