Rationale:Acute myocardial infarction in the presence of right bundle branch block.Patient concerns:A 70-year-old,male heavy smoker presented with angina and hypertension.Interventions:Electrocardiography,intravenous ...Rationale:Acute myocardial infarction in the presence of right bundle branch block.Patient concerns:A 70-year-old,male heavy smoker presented with angina and hypertension.Interventions:Electrocardiography,intravenous nitroglycerin infusion,intravenous streptokinase infusion.Diagnosis:Acute myocardial infarction in the presence of with changeable trifascicular heart block.Outcomes:Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution.Lessons:Acute myocardial infarction may be associated right bundle branch block.Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.展开更多
The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardi...The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardial infarction (AMI), delaying the diagnostic-therapeutic iter, with an important impact on prognosis. We describe the case of a woman of 59 years with LBBB, came to our observation for a constrictive chest pain associated with dyspnea. The diagnostic workup for suspected acute coronary syndrome (ACS), initially conducted only on the analysis of the electrocardiogram (negative TnI at entry), showed the presence of coronary arteries free of stenosis. However, the diagnostic confirmation of AMI was completed after the rise of cardiac markers and the electrocardiographic changes. This case confirm the difficulty about the diagnosis of AMI in patients with LBBB and stresses, however, as the use of some criteria proposed in the literature [1-3] can guide to its identification, directing patient to an appropriate treatment.展开更多
文摘Rationale:Acute myocardial infarction in the presence of right bundle branch block.Patient concerns:A 70-year-old,male heavy smoker presented with angina and hypertension.Interventions:Electrocardiography,intravenous nitroglycerin infusion,intravenous streptokinase infusion.Diagnosis:Acute myocardial infarction in the presence of with changeable trifascicular heart block.Outcomes:Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution.Lessons:Acute myocardial infarction may be associated right bundle branch block.Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.
文摘The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardial infarction (AMI), delaying the diagnostic-therapeutic iter, with an important impact on prognosis. We describe the case of a woman of 59 years with LBBB, came to our observation for a constrictive chest pain associated with dyspnea. The diagnostic workup for suspected acute coronary syndrome (ACS), initially conducted only on the analysis of the electrocardiogram (negative TnI at entry), showed the presence of coronary arteries free of stenosis. However, the diagnostic confirmation of AMI was completed after the rise of cardiac markers and the electrocardiographic changes. This case confirm the difficulty about the diagnosis of AMI in patients with LBBB and stresses, however, as the use of some criteria proposed in the literature [1-3] can guide to its identification, directing patient to an appropriate treatment.
