Clinical Impact of Newly Diagnosed Right Bundle Branch Block (RBBB) in ST Segment Elevation Myocardial Infarction (STEMI)

Abstract

A newly diagnosed Right Bundle Branch Block is being investigated as a potential electrographic diagnostic for life-threatening STEMI equivalents (RBBB). RBBB was identified in 7.3 percent of individuals with NSTEMI and 9.1 percent of patients with STEMI. Previously, urgent angiography was suggested for patients with STEMI and Left Bundle Branch Block (LBBB), but it is now recommended for patients with STEMI and Right Bundle Branch Block (RBBB), as it is a poor prognostic sign of a higher mortality in STEMI patients. We report on a 67-year-old woman presented with a chief complaint of continuous heartburn since ten hours before admission to the hospital. Complaints of cold sweating and had comorbidities of diabetes mellitus, hypertension, and ischemic stroke 2 months ago. On arrival, a 12-lead electrocardiogram (ECG) revealed STEMI inferior with RBBB. The cardiac enzyme marker was increased due to an elevated serum troponin-I level of 10 ng/mL (cut off 0,01), an elevated serum creatinine level of 3.7 mg/dL, leukocytosis (13850/L), and compensatory metabolic acidosis. She was treated with aspirin, clopidogrel, statins, ACE-i, and anticoagulants after being diagnosed with inferior STEMI with RBBB. As a practical matter of the COVID19 screening process, the patient did not require primary coronary intervention. The patient developed hemodynamic instability within two hours of being brought to the CVCU. The patient originally presented with transient ventricular tachycardia, which progressed to sustained ventricular tachycardia. Defibrillation with a dosage of 360 joules was used in conjunction with high-quality cardiopulmonary resuscitation until the patient was declared dead.