Diagnosis of Left Anterior Hemiblock in the Presence of Inferior Wall Myocardial Infarction

Castellanos, Agustín; Chahine, Robert A.; Chapunoff, Eduardo; Gomez, Jorge; Portillo, Bolívar

doi:10.1378/chest.60.6.543

Cited by 36 publications

(5 citation statements)

References 22 publications

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“…Those patients with a mean frontal plane QRS axis of -45' or more leftward, and initial right inferior vector with r waves in leads II, III, aVF, and with a Q wave in lead aVL, followed by a left superior vector, were included in this subgroup of patients with left anterior hemiblock. Those patients with left axis deviation with QS complexes and with no terminal R waves in leads II, III, and aVF were accepted as having a combination of an old inferior myocardial infarction and left anterior hemiblock (Rosenbaum et al, 1969a(Rosenbaum et al, , 1970Marriott and Hogan, 1970;Castellanos et al, 1971;Benchimol et al, 1972;Rosenbaum et al, 1972;Schamroth, 1975). Those with left axis deviation but not meeting the criteria for left anterior hemiblock were included in the second subgroup.…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

Büyüköztürk¹,

Korkut²,

Meriç³

et al. 1977

Heart

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In 700 patients with acute myocardial infarction admitted to the intensive coronary care unit of our hospital, the incidence and significance of left anterior hemiblock and left axis deviation has been studied in the acute phase of disease. In 102 (14-6%) of the 700 patients, isolated left axis deviation (mean QRS axis -45O) was found and 69 of them (9. 9%) met the criteria of left anterior hemiblock. Of the 69 patients with left anterior hemiblock, 61 had acute anterior myocardial infarction, 5 had inferior infarction, and 3 had subendocardial infarction. The left anterior hemiblock was transient in 5 patients, but persisted in 64. All patients with and without isolated left anterior hemiblock and left axis deviation were compared statistically with reference to mortality rate and the incidence of arrythmias; no significant difference was noted. However, in patients over the age of 65 and also in those with hypertension, the incidence of left axis deviation was significantly higher (P<0 05 and P<0-001, respectively).It was concluded that isolated left anterior hemiblock and left axis deviation occurring in the course of acute myocardial infarction had no influence on the prognosis of acute myocardial infarction.

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Section: Methodsmentioning

confidence: 99%

Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

Büyüköztürk¹,

Korkut²,

Meriç³

et al. 1977

Heart

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“…If this is the case, the VCG provides the typical pattern of inferior infarction in the presence of LAH. [17][18][19] The most characteristic finding of this association is found in the frontal plane of the VCG, where the initial 25-millisecond vector, instead of being oriented inferiorly and to the right, is inscribed to the right, usually with clockwise rotation. The remaining QRS loop rotates counterclockwise as expected in LAH ( Figure 5).…”

Section: Inferior Wall Myocardial Infarction Concealed By Lahmentioning

confidence: 99%

Hemiblocks Revisited

2007

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Abstract-The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures. Key Words: epidemiology Ⅲ heart septal defects Ⅲ myocardial infarction Ⅲ heart block Ⅲ bundle-branch block T hirty-eight years have elapsed since Rosenbaum et al published their seminal work that put together diverse previous observations and brought about a rational and complete analytic approach to the trifascicular concept of intraventricular conduction.These conclusive studies and an exhaustive review of the preceding knowledge of the subject were first published in the Spanish monograph, 1 and later a shorter updated version was presented to acquaint the English reader with the electrocardiographic manifestations and clinical correlation of the abnormal spread of ventricular excitation. 2 A series of articles published by the same authors between 1969 and 1973 also contributed to the expansion of the recognition of this research work. As stated by Herman N. Uhley, 3 this work triggered and infl...

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“…Although rare, LPFB is a clinically important intraventricular conduction disturbance. Its appearance is reliably connected with inferior wall MI and generally reflects severe two- or three-vessel disease, requiring invasive investigation [[11], [12], [13]].…”

Section: Epidemiologymentioning

confidence: 99%

Left posterior fascicular block, state-of-the-art review: A 2018 update

Pérez‐Riera

Barbosa‐Barros

Daminello‐Raimundo

et al. 2018

Indian Pacing and Electrophysiology Journal

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We conducted a review of the literature regarding epidemiology, clinical, electrocardiographic and vectorcardiographic aspects, classification, and differential diagnosis of left posterior fascicular block.Isolated left posterior fascicular block (LPFB) is an extremely rare finding both in the general population and in specific patient groups. In isolated LPFB 20% of the vectorcardiographic (VCG) QRS loop is located in the right inferior quadrant and when associated with right bundle branch block (RBBB) ≥40%.The diagnosis of LPFB should always consider the clinical aspects, because a definite diagnosis cannot be made in the presence of right ventricular hypertrophy (RVH) (chronic obstructive pulmonary disease (COPD)/emphysema), extensive lateral myocardial infarction (MI) or extremely vertical heart.Intermittent LPFBs are never complete blocks (transient or second degree LPFB) and even in the permanent ones, one cannot be sure that they are complete. When LPFB is associated with RBBB and acute inferior MI, PR interval prolongation is very frequent.

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Diagnosis of Left Anterior Hemiblock in the Presence of Inferior Wall Myocardial Infarction

Cited by 36 publications

References 22 publications

Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

Hemiblocks Revisited

Left posterior fascicular block, state-of-the-art review: A 2018 update

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