Posterior Myocardial Infarction and Complete Right Bundle- Branch Block

Madias, John E.; Bravidis, Demetrius; Attari, Mehran

doi:10.1378/chest.122.5.1860

Cited by 6 publications

(9 citation statements)

References 14 publications

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“…First, the presence of tall R waves in V2-V3 preceding R' is abnormal in RBBB as the early depolarization vector in RBBB typically reflects normal left ventricular depolarization. In this case, the tall R waves in V2-V3 likely represent large posterior Q waves suggestive of transmural infarction [2]. In addition, typical RBBB is manifested by discordant T-wave inversions in V1-V3.…”

Section: Discussionmentioning

confidence: 78%

ECG Changes in a Case of Posterior Myocardial Infarction in the Presence of Right Bundle Branch Block

Ramjaun¹,

Garg²,

Klaiman³

et al. 2021

Cureus

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A 70-year-old male with hypertension and diabetes presented to the emergency department with a 1-hour history of chest pain. Initial 12-lead ECG revealed a right bundle branch block (RBBB) and ST depression (STD) in V2-V4. The anterior STD prompted a 15-lead ECG in which there was no evidence of ST elevation (STE). With a positive troponin, cardiology was consulted and the patient was admitted as a highrisk non-ST-elevation myocardial infarction (NSTEMI). Subsequently, his chest pain returned without further ST changes, regardless the patient went for emergency coronary angiography, which found a complete occlusion of the left circumflex artery. Anterior STD is a normal finding in RBBB and posterior STEs in the posterior leads are not always present making the recognition of posterior STEMI difficult. This case highlights three findings in leads V1-V3 that are concerning for posterior ischemia in the context of chest pain and an RBBB: tall R waves, upright T waves, and marked STD > 2 mm. This should prompt serial 15-lead ECGs and prompt cardiology consultation.

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Section: Discussionmentioning

confidence: 78%

ECG Changes in a Case of Posterior Myocardial Infarction in the Presence of Right Bundle Branch Block

Ramjaun¹,

Garg²,

Klaiman³

et al. 2021

Cureus

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“…It is common in patients having anterior wall myocardial infarction with accompanying left ventricular dysfunction . [13] Supraventricular tachycardias increases the myocardial oxygen demand and consumption and further increases the myocardial ischaemia. The atrioventricular blocks are common in inferior wall myocardial infarction and bundle branch block are common in the anterior wall myocardial infarction .…”

Section: Discussionmentioning

confidence: 99%

“…The varied presentation does not confer any correlation with the type of conduction blocks. 11,10 The incidence of ventricular fibrillation with stem has declined drastically over the past decade. Ventricular premature beats with tachycardia is alone treated with beta adrenergic drugs in CAD patients .…”

Section: Discussionmentioning

confidence: 99%

The Study of Demographic Profile of Conduction Defects in Acute Myocardial Infarction

Selvaraj¹,

Mamallan²

2019

jemds

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BACKGROUND Arrhythmias that develop at the time of acute myocardial infarction, and during its treatment are one of the major causes of death in a patient with acute coronary syndrome. Acute myocardial infarction is becoming the leading cause of death in developing countries, more than the infectious diseases. We wanted to study the various conduction defects in myocardial infarction and their demographic profile in a tertiary care teaching hospital in Kilpauk, Chennai, India. METHODS 100 patients with acute myocardial infarction were evaluated from September 18 to December 18, in the age group of 25-90 years, with typical ECG changes, and rise in cardiac enzymes, were included in the study. Those who had pre-existing conduction defects were excluded from the study. RESULTS The incidence of conduction block is around 22%. Conduction blocks are more common in males and in anteroseptal infarctions. The common age in females are postmenopausal age. Mortality is common in anterior wall than inferior wall MI. The conduction blocks are common in first 24 hrs of hospitalization. CONCLUSIONS The incidence of conduction defects was about 22% of the total myocardial infarction patients with higher male preponderance. Chest pain is the predominant symptom. In women, it was common in postmenopausal age group. Diabetes and hypercholesterolemia are the commonest comorbid illnesses. AV blocks are common in inferior wall infarction. The most vulnerable period is the first 24 hours. Conduction blocks are common in anterior wall infarction. Complete heart block associated with anterior wall myocardial infarction has the worst prognosis. Thrombolysed patients have increased risk of conduction defects than nonthrombolysed patients. Careful monitoring and prompt treatment of conduction defects and their common complications in a patient with acute myocardial infarction is very important in preventing mortality and morbidity among these patients

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“…The AHA/ACC/HRS establish that the ECG diagnosis of myocardial infarction (MI) does not modify in the presence of RBBB or fascicular blocks, 8 but the diagnosis of MI in this situation is challenging 6 . There are several findings that suggest MI in the presence of RBBB 9 : MI of the mid-interventricular septum: R wave disappears in V1–V2 (with new onset of QR or qR complex) and there is no Q wave in V5–V6. MI of the inferior interventricular septum: the vectors that run through the mid and low septum disappear, with the appearance of QR or QS complex in V3–V4. MI of the left ventricle free wall: it is manifested by the presence of qrS or QrS in v5–v6, with q or Q and S always notched.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the American Heart Association (AHA)/American College of Cardiology Foundation (ACCF)/Heart Rhythm Society (HRS) standardization recommendations of acute ischaemia 4 and in the 2017 European Society of Cardiology (ESC) guidelines of acute myocardial infarction with ST-segment elevation (STEMI) the definition of PMI is maintained and recommends immediate reperfusion 5 . There are few reports of the association of PMI and right bundle branch block (RBBB); 6 this represents a challenge in diagnosis due to the finding of broad R waves and ventricular repolarization disorders in right precordial leads in both entities.…”

Section: Introductionmentioning

confidence: 99%

Case report: Posterior myocardial infarction in presence of right bundle branch block: an old concept with new findings

Cornejo-Guerra

Manzur‐Sandoval

Guadalajara-Boo

et al. 2018

European Heart Journal - Case Reports

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Background The diagnosis of acute ischaemic coronary syndromes in presence of an intra-ventricular conduction disturbance represents a clinical challenge. In the cardiac segmentation model the posterior wall is replaced by the basal inferior segment. However, in the clinical scenario of acute coronary syndrome the concept of posterior myocardial infarction (PMI) endures. The association of a PMI and right bundle branch block (RBBB) is a rare condition characterised by broad R waves and ventricular repolarization disorders in right precordial leads in both entities, which could lead to misinterpretation and delay in reperfusion therapy. Case Summary We describe a case report of a 74-year-old man with acute chest pain and an electrocardiogram with broad R waves, a 4 mm ST-segment downsloping (excessively discordant) in right precordial leads, RBBB, and ST-segment elevation in posterior leads. There was resolution of ST-segment downsloping in right precordial leads after percutaneous coronary intervention and stenting of the circumflex artery, with disturbance of the repolarization process only attributable to RBBB. Discussion Patients with acute chest pain with RBBB and a ST segment with an excessive downsloping (out of proportion of what is expected in isolated RBBB) suggest PMI with occlusion of the circumflex coronary artery.

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Posterior Myocardial Infarction and Complete Right Bundle- Branch Block

Cited by 6 publications

References 14 publications

ECG Changes in a Case of Posterior Myocardial Infarction in the Presence of Right Bundle Branch Block

ECG Changes in a Case of Posterior Myocardial Infarction in the Presence of Right Bundle Branch Block

The Study of Demographic Profile of Conduction Defects in Acute Myocardial Infarction

Case report: Posterior myocardial infarction in presence of right bundle branch block: an old concept with new findings

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