False-Negative and False-Positive ECG Diagnoses of Q Wave Myocardial Infarction in the Presence of Right Bundle-Branch Block

Gussak, Ihor; Wright, R. Scott; Bjerregaard, Preben; Chaitman, Bernard R.; Zhou, Sophia H.; Hammill, Stephen C.; Kopecky, Stephen L.

doi:10.1159/000047312

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…Myocardial infarction always affects the left ventricle leading to impairment of the initial phase of ventricular depolarization, producing abnormal Q waves. 4,5 In contrast, RBBB delays the terminal phase of ventricular depolarization, producing a wide R' wave in the right chest leads and a wide S wave in the left chest leads but no abnormal Q waves, as seen in our case (Figure 1). 4,5 In conclusion, our case demonstrates a misreading of an inferior wall ST-segment elevation myocardial infarction in a patient with complete right bundle branch block.…”

supporting

confidence: 56%

“…4,5 In contrast, RBBB delays the terminal phase of ventricular depolarization, producing a wide R' wave in the right chest leads and a wide S wave in the left chest leads but no abnormal Q waves, as seen in our case (Figure 1). 4,5 In conclusion, our case demonstrates a misreading of an inferior wall ST-segment elevation myocardial infarction in a patient with complete right bundle branch block. It is important for clinicians to know about other clinical presentations that could be misdiagnosed as acute coronary syndrome, since this misdiagnosis can lead to important complications.…”

supporting

confidence: 56%

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Right bundle branch block masquerading as acute ST-segment elevation myocardial infarction

Vutthikraivit¹,

Suchartlikitwong²

2020

The Chronicles

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supporting

confidence: 56%

supporting

confidence: 56%

Right bundle branch block masquerading as acute ST-segment elevation myocardial infarction

Vutthikraivit¹,

Suchartlikitwong²

2020

The Chronicles

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“…There are also limitations of this study. We used ECG criteria for defining UMI, though Q-waves on ECG are absent in some patients with documented MI [17], may be due to conditions other than MI [18,19], and do not agree well with myocardial scars detected on cardiac magnetic resonance imaging with gadolinium contrast [19]. The inability to detect UMI not associated with Q-waves is an inherent limitation of the ECG method for detection of UMI; however, the use of the MC scheme reduces the concern about Q-waves due to other conditions which take precedence over MI in the coding system [12].…”

Section: Discussionmentioning

confidence: 99%

Assessment tools for unrecognized myocardial infarction: a cross-sectional analysis of the REasons for geographic and racial differences in stroke population

Levitan

Safford

Kilgore

et al. 2013

BMC Cardiovasc Disord

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BackgroundRoutine electrocardiograms (ECGs) are not recommended for asymptomatic patients because the potential harms are thought to outweigh any benefits. Assessment tools to identify high risk individuals may improve the harm versus benefit profile of screening ECGs. In particular, people with unrecognized myocardial infarction (UMI) have elevated risk for cardiovascular events and death.MethodsUsing logistic regression, we developed a basic assessment tool among 16,653 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study using demographics, self-reported medical history, blood pressure, and body mass index and an expanded assessment tool using information on 51 potential variables. UMI was defined as electrocardiogram evidence of myocardial infarction without a self-reported history (n = 740).ResultsThe basic assessment tool had a c-statistic of 0.638 (95% confidence interval 0.617 - 0.659) and included age, race, smoking status, body mass index, systolic blood pressure, and self-reported history of transient ischemic attack, deep vein thrombosis, falls, diabetes, and hypertension. A predicted probability of UMI > 3% provided a sensitivity of 80% and a specificity of 30%. The expanded assessment tool had a c-statistic of 0.654 (95% confidence interval 0.634-0.674). Because of the poor performance of these assessment tools, external validation was not pursued.ConclusionsDespite examining a large number of potential correlates of UMI, the assessment tools did not provide a high level of discrimination. These data suggest defining groups with high prevalence of UMI for targeted screening will be difficult.

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“…Wide complex ECGs were only evaluated for fQRS complexes due to the poor specificity of Q waves in this setting. (18,19)…”

Section: Methodsmentioning

confidence: 99%

The Selvester QRS Score is more accurate than Q waves and fragmented QRS complexes using the Mason-Likar configuration in estimating infarct volume in patients with ischemic cardiomyopathy

Carey¹,

Luísi²,

Baldwa³

et al. 2010

Journal of Electrocardiology

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Infarct volume independently predicts cardiovascular events. Fragmented QRS complexes (fQRS) may complement Q-waves for identifying infarction; however, their utility in advanced coronary disease is unknown. We tested whether fQRS could improve the ECG prediction of infarct volume by PET in 138 patients with ischemic cardiomyopathy (EF 0.27±0.09). Indices of infarction (pathologic Q-waves, fQRS, and Selvester QRS Score) were analyzed by blinded observers. In patients with QRS duration <120ms, number of leads with pathologic Q-waves (mean 1.6±1.7) correlated weakly with infarct volume (r=0.30, p<0.05). Adding fQRS increased the number of affected leads (3.6±2.5), but the significant correlation with infarct volume was lost (r=0.02, p=0.10). Selvester Score was the most accurate (mean 5.9±4.9 points; r=0.49, p<0.001). fQRS was not predictive of infarct size in patients with QRS duration ≥120ms (r=0.02, p=0.19). Thus in ischemic cardiomyopathy, consideration of fQRS complexes does not improve Q-wave prediction of infarct volume, but Selvester Score was more accurate.

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False-Negative and False-Positive ECG Diagnoses of Q Wave Myocardial Infarction in the Presence of Right Bundle-Branch Block

Cited by 13 publications

References 30 publications

Right bundle branch block masquerading as acute ST-segment elevation myocardial infarction

Right bundle branch block masquerading as acute ST-segment elevation myocardial infarction

Assessment tools for unrecognized myocardial infarction: a cross-sectional analysis of the REasons for geographic and racial differences in stroke population

The Selvester QRS Score is more accurate than Q waves and fragmented QRS complexes using the Mason-Likar configuration in estimating infarct volume in patients with ischemic cardiomyopathy

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