Transient prominent anterior QRS forces in the setting ST segment elevation coronary syndrome: Left septal fascicular block

Pérez‐Riera, Andrés Ricardo; Barbosa‐Barros, Raimundo; Neto, Antônio Fernandes Silva e Sousa; Daminello‐Raimundo, Rodrigo; Abreu, Luíz Carlos de; Nikus, Kjell

doi:10.1016/j.jelectrocard.2018.06.006

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…Perhaps most importantly, these wall motion abnormalities do not follow the territories supplied by one coronary vessel. 11 M. Muneeb, A. U. K. Niazi, Z. J. Chatha et al P J M H S Vol. 17, No.…”

Section: Resultsmentioning

confidence: 99%

“…But it was studied retrogradely in established patients of TCM & compared it with acute anterior wall myocardial infarction. [16][17][18][19] Unfortunately, no such study, either through ECG or coronary angiography has not yet taken place in Pakistan. In Pakistan, our study is the first of its type to assess the diagnostic accuracy of ECG in differentiating TC from anterior wall myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

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The Diagnostic Accuracy of Electrocardiogram in Differentiating Takotsubo Cardiomyopathy in Patients Presenting as Anterior Wall St-Segment Elevation Myocardial Infarction and Taking Coronary Angiography as Gold Standard

Muneeb,

Niazi,

Chatha

et al. 2023

PJMHS

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Myocardial infarction: Myocardial infarction is the irreparable damage to heart muscles resulting in necrosis & is the leading cause of death; resulting in 500,000-700,000 important deaths related to the coronary artery occur each year. Cardiovascular disease is the most common reason resulting in premature mortality as well as morbidity among various ethnic group of white, black and Hispanic populations. Takotsubo Cardiomyopathy: TCM is a condition that affects the heart reversible syndrome, characteristic of decrease(hypokinesia)/ near absent movement (akinesia) of distal half of interventricular septum & cardiac apex showed as apical ballooning on echocardiogram with absence of an obstructive defect in epicardial coronary arteries following an emotional disturbance. Objective: To determine the diagnostic accuracy of electrocardiographic findings (elevation < 1mm Takotsubo cardiomyopathy can be identified in lead V1 in patients who have anterior wall ST-segment elevation myocardial infarction by taking coronary angiography as gold standard. Design: Cross-sectional survey Subjects & Methods: Using 250 incidences in the sample, and a 95% confidence level, a 13% error margin, and the anticipated percentage of Takotsubo cardiomyopathy i.e, 18% by using 74.2% sensitivity and 80.6% specificity of electrocardiographic findings i.e, ST-elevation of > 1mm in V1 in the detection of Takotsubo cardiomyopathy when myocardial infarction with ST-elevation in the anterior wall is the presenting symptom and coronary angiography as gold standard2. Results: The patients were 49 + 13 years old on average. Sensitivity & specificity of ECG criteria were 40.78% & 78.65%. The positive & negative predictive values were 43.28% & 76.5% respectively. Practical Implication: Our study showed negative association of ST-elevation of >1mm in ECG lead V1 to differentiate TC from anterior wall myocardial infarction. Further studies should be done to probe into the diagnostic accuracy of ECG in differentiating TC from acute anterior wall myocardial infarction. Conclusion: Electrocardiography is not diagnostic for distinguishing acute anterior wall pain from Takotsubo cardiomyopathy myocardial infarction so additional investigations need to be performed to diagnose the Takotsubo Cardiomyopathy. Keywords: Myocardial infarction, Takotsubo cardiomyopathy, Electrocardiogram, diagnostic accuracy Coronary angiography.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Diagnostic Accuracy of Electrocardiogram in Differentiating Takotsubo Cardiomyopathy in Patients Presenting as Anterior Wall St-Segment Elevation Myocardial Infarction and Taking Coronary Angiography as Gold Standard

Muneeb,

Niazi,

Chatha

et al. 2023

PJMHS

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“…The proposed ECG criteria for LSFB include normal or slightly increased (up to 110 ms) QRS duration, R-wave voltage of V1 ≥ 5 mm, R wave of V2 > 15 mm, and absence of a q wave in the left precordial leads V5, V6 and in the lead I [26]. Two case reports from patients ST-elevation ACS, one with anterior and one with inferior ST elevation, and prominent anterior forces, indicating LSFB, were reported [27,28].…”

Section: Fascicular Blockmentioning

confidence: 99%

Conduction Disorders in the Setting of Acute STEMI

Nikus

Birnbaum

Fiol‐Sala

et al. 2021

CCR

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: ST-elevation myocardial (STEMI) is frequently associated with conduction disorders. Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations, and neural reflexes or changes in the balance of the autonomous nervous system may be involved. Sinoatrial and atrioventricular block are more frequent in inferior than anterior STEMI, while new left anterior fascicular block and right bundle branch block indicate proximal occlusion of the left anterior descending coronary artery. New left bundle branch block is associated with multi-vessel disease. Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they may still impair prognosis, because they indicate a large area at risk, extensive myocardial infarction or severe coronary artery disease. Acute STEMI recognition is possible in patients with fascicular or right bundle branch block, but future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral MI and for ST elevation in the same leads in anterior STEMI. In left bundle branch block, concordant ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has low sensitivity.

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