The clinical significance of true left axis deviation

Pryor, Ray; Blount, S. Gilbert

doi:10.1016/s0002-8703(66)80014-5

Cited by 166 publications

(40 citation statements)

References 45 publications

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“…1961;Hiss and L amb, 1962], it is possible that the conduction disturbance in these pa tients was related to the chronic and severe anemia with consequent ven tricular dilatation, considering the vulnerability of the right fascicle. Mus cular dystrophy and diabetes mellitus are also recognised underlying causes of fascicular blocks [Payne and G reeneild, 1963;Pryor and Blount, 1966]. In our series, however, it is still not possible to assess the frequency as, at present, electrocardiograms are not usually requested for in the majority of these patients.…”

Section: Discussionmentioning

confidence: 83%

“…These are well-recog nised associated diseases [Pryor and Blount, 1966 Although coronary heart disease is apparently uncommon in this country [William s, 1971; F alase ei al., 1973J, a sub-clinical association of this disease in the older and longstanding hypertensive patients in the series is still a possibility. However, our findings in general may favour the recent contention that the role of coronary heart disease in the production of intraventricular conduction blocks has been over-emphasised [Harris ei al., 1969;D avies and H arris, 1969].…”

Section: Discussionmentioning

confidence: 97%

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Fascicular Conduction Blocks and their Relationship to Complete Heart Block in Nigerians

Cole¹,

Falase²

1975

Cardiology

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Following electrocardiographic analysis, isolated or combined blocks in the intraventricular trifascicular system including predivisional left bundle branch block with left posterior hemiblock in Nigerians are presented and the underlying causes reviewed. The rarity of complete heart block, despite the not uncommon fascicular blocks, is of interest and may be related to the population age structure considering the invariably slow rate of degeneration of conduction fibres in the system.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 97%

Fascicular Conduction Blocks and their Relationship to Complete Heart Block in Nigerians

Cole¹,

Falase²

1975

Cardiology

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“…Each of these areas was further subdivided into two basal, two central and one apical zone, for a total of 15 zones ( fig. 1) [6][7][8][9][10], between the anterior septal attachment and the lateral border of the anterior papillary muscle (and usually the circumflex artery); and posteroinferior (zones [11][12][13][14][15], from the lateral border of the anterior papillary muscle (and circumflex artery) to the posteroinferior septal attachment (and posterior descending artery). These regions were each divided into one apical, two central and two basal portions, for a total of 15 zones.…”

Section: Methodsmentioning

confidence: 99%

The pathologic correlates of the electrocardiogram: complete left bundle branch block.

Havelda¹,

Sohi²,

Flowers³

et al. 1982

Circulation

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To assess whether gross pathologic differences exist between hearts with left bundle branch block (LBBB) and left-axis deviation (LAXD) and those with LBBB and a normal frontal plane axis, we examined 70 hearts with LBBB in a series of 1410 sequential dissections (5%). Thirty-two hearts had LAXD and 34 had normal axes on the correlative ECG. Left ventricular enlargement occurred frequently (93%). No significant differences were found in age distribution, left ventricular weight, coronary anatomy or infarct location. Quantitative analysis revealed larger inferoposterolateral and apical infarcts in hearts with LBBB and LAXD (p less than 0.01). The accuracy of various electrocardiographic signs of left ventricular enlargement and myocardial infarction in the presence of LBBB was assessed. Voltage criteria and QRS duration poorly define anatomic chamber enlargement. Anterior infarction is suggested by a q or pathological Q wave in lead I, a q wave in leads I, V5 and V6, or notched S waves in V3 or V4. Pathologic q waves or ST shifts in the inferior leads have high diagnostic specificity but low sensitivity for inferior infarction.

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“…'2 The most common etiology is arteriosclerotic heart disease.9 10, 13 The greater vulnerability of the left anterior division of Although vectorcardiography may suggest LAH complicating inferior wall infarction,2 4 definite anatomic confirmation is not available. A large inferobasal infarction might account for the same vectorcardiographic pattern.…”

Section: Discussionmentioning

confidence: 99%

Incidence and significance of left anterior hemiblock complicating acute inferior wall myocardial infarction.

Kourtesis¹,

Lichstein²,

Chadda³

et al. 1976

Circulation

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SUMMARY The hospital course and serial vectorcardiograms of 56 consecutive patients with acute inferior wall myocardial infarction were reviewed. Left anterior hemiblock (LAH) complicating inferior wall myocardial infarction was diagnosed by vectorcardiographic criteria. Seven patients (12.5%) developed LAH between the first and third hospital day, while 49 patients did not. There was no significant LEFT ANTERIOR HEMIBLOCK (LAH) may be difficult to diagnose in the presence of inferior wall myocardial infarction due to the frequent leftward shift of the frontal plane QRS forces by the infarcted area.' Vectorcardiographic criteria have been described by Castellanos,2 Kulbertus,3 and Benchimol4 which enable the diagnosis of LAH to be made in the presence of inferior wall myocardial infarction. It is the purpose of this study, using these criteria, to examine prospectively patients with inferior wall myocardial infarction and to determine the incidence and clinical significance of the complication of acute LAH. MethodsData were reviewed on 56 consecutive patients admitted to a coronary care unit with acute inferior wall myocardial infarction. Patients with LAH at the time of admission were not included. The criteria for diagnosis were: 1) History of ischemic chest pain.2) Significant Q waves and ST-segment elevation in leads II, III, aVF with reciprocal ST-segment depression in leads I and aVL. a) Associated lateral wall involvement was diagnosed by appearance of a 0.04 sec Q wave and ST elevation in leads V5 and V6. 3) Serial changes of serum glutamic oxaloacetic transaminase, lactic dehydrogenase, and creatinine phosphokinase. All patients were admitted to the coronary care unit within the first 24 hours following onset of acute chest pain and were constantly monitored using a nonfade television and display, and a V, monitor lead. A 12-lead electrocardiogram was recorded daily or more often if indicated clinically. Routine coronary care included a constant intravenous infusion of lidocaine (average 2 mg/min) and heparin 75 mg intravenously every six hours, unless specific difference between these two groups when compared for age, sex, incidence of congestive heart failure, atrial and ventricular arrhythmias, atrioventricular (A-V) block, hospital mortality, and previous hypertension, diabetes mellitus, and myocardial infarction. We conclude that LAH is a relatively common complication of acute inferior wall myocardial infarction, with no apparent effect on the clinical course.contraindications were present in a patient. Vectorcardiograms using the Frank lead system were recorded on day one and day three and on the basis of these studies the patients were separated into two groups.Group I: Patients with conventional frontal plane vectorcardiographic criteria for inferior wall infarction.'-7 a) Superior orientation and clockwise rotation of the initial 25 msec vector. Group II: Patients with frontal plane vectorcardiographic criteria for inferior wall infarction coexisting with LAH.' a) Clockwise and superior inscri...

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The clinical significance of true left axis deviation

Cited by 166 publications

References 45 publications

Fascicular Conduction Blocks and their Relationship to Complete Heart Block in Nigerians

Fascicular Conduction Blocks and their Relationship to Complete Heart Block in Nigerians

The pathologic correlates of the electrocardiogram: complete left bundle branch block.

Incidence and significance of left anterior hemiblock complicating acute inferior wall myocardial infarction.

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