Diagnostic and prognostic value of ST-segment deviations in patients with suspected myocardial infarction and right bundle branch block

2021 ◽  
Vol 69 ◽  
pp. 89-90
Author(s):  
Mohammad Toma ◽  
Yama Fakhri ◽  
Hedvig Andersson ◽  
Mathilde Jessen ◽  
Lisette Jensen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Right Bundle Branch Block ◽  
Prognostic Value ◽  
Bundle Branch Block ◽  
St Segment ◽  
Diagnostic And Prognostic Value

scholarly journals Apparent ST elevation in right bundle branch block pseudo-mimicking myocardial infarction

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982774 ◽  
Author(s):  
Itsuro Kazama ◽  
Toshiyuki Nakajima
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Cardiac Death ◽  
Close Monitoring ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
St Elevation

We report a case of right bundle branch block, in which the patient’s symptoms and the electrocardiogram findings mimicked those of acute coronary syndrome. In this case report, we stress the significance of apparent ST segment elevation in right bundle branch block. The differential diagnosis is important because right bundle branch block is often complicated with acute coronary syndrome. In addition, right bundle branch block with an ST segment elevation in the specific leads can be a predictor of sudden cardiac death. In such cases, close monitoring of the electrocardiogram findings and careful observation of the patient’s symptoms would be necessary.

scholarly journals Differences in presentation and clinical outcomes between left or right bundle branch block and ST segment elevation in patients with acute myocardial infarction

2020 ◽  
Vol 9 (8) ◽  
pp. 848-856
Author(s):  
Matthias R Meyer ◽  
Dragana Radovanovic ◽  
Giovanni Pedrazzini ◽  
Hans Rickli ◽  
Marco Roffi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Bundle Branch Block ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Cerebrovascular Events ◽  
St Segment ◽  
Ischaemic Attack

Background: In patients with acute myocardial infarction, the presence of a left bundle branch block or right bundle branch block may be associated with worse prognosis compared to isolated ST segment elevation. However, specificities in clinical presentation and outcomes of acute myocardial infarction patients with left bundle branch block or right bundle branch block are poorly characterized. Methods: We analysed acute myocardial infarction patients with left bundle branch block ( n=880), right bundle branch block ( n=732) or ST segment elevation without bundle branch block ( n=15,852) included in the Acute Myocardial Infarction in Switzerland-Plus registry between 2008–2019. Results: Acute myocardial infarction patients with bundle branch block were older and had more pre-existing cardiovascular conditions compared to ST segment elevation. Pulmonary oedema and cardiogenic shock were most frequent in patients with left bundle branch block (18.8% vs 12.0% for right bundle branch block and 7.9% for ST segment elevation, p<0.001). Acute myocardial infarction patients with bundle branch block had more three-vessel (40.6% vs 25.3%, p<0.001 vs ST segment elevation) and left main disease (5.6% vs 2.0%, p<0.001 vs ST segment elevation). Major adverse cardiac and cerebrovascular events, a composite of reinfarction, stroke/transient ischaemic attack, and death during hospitalization, were highest in acute myocardial infarction patients with left bundle branch block (13.9% vs 9.9% for right bundle branch block and 6.7% for ST segment elevation, p<0.05), which was driven by hospital mortality. After multivariate adjustment, however, mortality was similar in patients with left bundle branch block and lower in patients with right bundle branch block, respectively, when compared to ST segment elevation. Mortality was only increased when a right bundle branch block with concomitant STE was present (odds ratio 1.77, 95% confidence interval 1.19–2.64, p<0.01 vs ST segment elevation). Conclusions: Compared to ST segment elevation, an isolated bundle branch block reflects high-risk clinical characteristics but does not independently determine increased hospital mortality in acute myocardial infarction.

Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 256-262 ◽  
Author(s):  
Fahad Alkindi ◽  
Ayman El-Menyar ◽  
Ihsan Rafie ◽  
Abdulrahman Arabi ◽  
Jassim Al Suwaidi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Right Bundle Branch Block ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( P = .001), more likely to present with breathlessness rather than chest pain ( P = .001), and had more diabetes mellitus ( P = .001). Patients with RBBB had significantly higher cardiac enzymes ( P = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, P = .001), cardiogenic shock (10.6% vs 1.7%, P = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, P = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, P = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.

scholarly journals Right bundle branch block in patients with suspected myocardial infarction

2018 ◽  
Vol 8 (2) ◽  
pp. 161-166 ◽  
Author(s):  
Johannes Tobias Neumann ◽  
Nils Arne Sörensen ◽  
Nicole Rübsamen ◽  
Francisco Ojeda ◽  
Sarina Schäfer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Right Bundle Branch Block ◽  
European Society ◽  
Final Diagnosis ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
One Year ◽  
European Society Of Cardiology

Aims: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction. Methods and results: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71–2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17–2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28–4.05; P=0.005) for BFB. Conclusion: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.

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