scholarly journals Electrocardiographic signs of acute myocardial infarction in left bundle branch block

2013 ◽  
Vol 66 (11-12) ◽  
pp. 503-506
Author(s):  
Igor Ivanov ◽  
Sonja Bugarski ◽  
Jadranka Dejanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Jasna Radisic-Bosic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Sensitivity And Specificity ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Duration Of Symptoms ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Introduction. Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. Literature Review. Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations. The most widely used and recognized criterion is Sgarbossa scoring system that includes concordant ST segment elevation > 1 mm ST segment, disconcordant denivelation of ST segment > 1 mm in the leads V1-V3 and disconcordant ST segment elevation > 5 mm with acceptable sensitivity and specificity. In subsequent studies, the sensitivity and specificity increased by replacing the third criterion with ST/S ratio < -0.25. Conclusion. The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.

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.

scholarly journals High risk electrocardiographic patterns in patients with acute coronary syndrome.

2020 ◽  
Vol 2 (1) ◽  
pp. 25-34
Author(s):  
Diego Echeverri- Marín ◽  
Cristhian Felipe Ramirez Ramos ◽  
Andrés Miranda-Arboleda ◽  
Gustavo Castilla-Agudelo ◽  
Clara Saldarriaga-Giraldo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Reperfusion Therapy ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Acute Coronary Occlusion ◽  
St Segment ◽  
St Elevation ◽  
Electrocardiographic Findings

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

scholarly journals Clinical examples of microcirculation disorders in acute myocardial infarction

2016 ◽  
Vol 15 (1) ◽  
pp. 56-64
Author(s):  
K. A. Kireev ◽  
A. V. Krasnopeev
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Fatal Outcome ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Angiographic Result

Objective. To improve the results of acute myocardial infarction (AMI) treatment. Material and methods. We have analyzed 2 clinical cases of unfavorable course of AMI. Results. The middle aged patient who had ST segment elevation acute coronary syndrome received immediate full reperfusion therapy (thrombolysis and stenting). It was performed early in the course of the disease and demonstrated good angiographic result. Postoperatively there were no typical evolution of ECG signs of AMI. By the end of the first day we registered stent thrombosis with fatal outcome. Cause of death: acute left ventricular failure. The area of infarcted cardiac muscle was about 40 %, in the projection of the apex of the left ventricle the acute aneurysm was formed. Perhaps this situation has been associated with disorders of microcirculation in the infarcted area, which can be potentially neutralized by inhibitors 2b/3a receptors of platelets. This drug was given to this patient too late (during rethrombosis). In another observation (with the same circumstances) the inhibitor of IIb/IIIa GP receptors was given during the early postoperative period, what was followed by the natural course of AMI. Conclusion. These examples demonstrate the need of additional antiplatelet support (inhibitor IIb/IIIa GP receptors) in such clinical situations.

scholarly journals Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

2016 ◽  
Vol 43 (3) ◽  
pp. 258-260 ◽  
Author(s):  
Jonathan Winkler ◽  
Sunit-Preet Chaudhry ◽  
Philip H. Stockwell
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Cardiac Catheterization ◽  
Acute Chest Pain ◽  
Initial Presentation ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Septic Embolization ◽  
St Segment

Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myocardial infarction.

scholarly journals Left bundle branch block and Wavy triple sign (Yasser’s sign) intertwining COVID-19 Pneumonia with Renal Impairment; defective Sgarbosa criteria for Thrombolytic: A Case Report in Cardiology, Infectious Diseases, Nephrology and Critical Care Medicine

2021 ◽  
Vol 2 (1) ◽  
pp. 01-05
Author(s):  
Yasser Elsayed
Keyword(s):  
Myocardial Infarction ◽  
Renal Impairment ◽  
Left Bundle Branch Block ◽  
Blood Gases ◽  
Current Case ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Arterial Blood ◽  
St Segment

Rationale: Left bundle branch block is a diagnostic utility for ST-segment elevation myocardial infarction equivalent. Consequently, administration of thrombolytic is a pivotal step. Emergent Sgarbosa criteria and their modification are considered helpful guide keys. Wavy triple an electrocardiographic sign (Yasser Sign) is a novel diagnostic sign in hypocalcemia. Interestingly, the presentation of COVID-19 pneumonia with an intertwining left bundle branch block, renal impairment, and hypocalcemia has a risk impact on both morbidity and mortality of COVID-19 patients. Patient concerns: An elderly carpenter male COVID-19 patient was admitted to intensive care unit with COVID-19 pneumonia with interlacing left bundle branch block, renal impairment, and Wavy triple sign (Yasser’s sign). Diagnosis: Left bundle branch block and Wavy triple sign (Yasser’s sign) intertwining COVID-19 pneumonia with renal impairment. Interventions: Arterial blood gases, chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The triage of the left bundle branch block with the COVID-19 patient is highly significant for both diagnosis of acute myocardial infarction and giving thrombolytic. The combination of left bundle branch block, renal impairment, and hypocalcemia COVID-19 pneumonia signifies the risk in the current case study.

scholarly journals Can inflammatory biomarkers play a role in the inclusion of patients with acute myocardial infarction in cardiac rehabilitation programs?

2021 ◽  
Vol 12 (3) ◽  
pp. 255-260
Author(s):  
Alexandra DĂDÂRLAT-POP ◽  
Horea ROȘIANU ◽  
Renaldo POPTILE ◽  
Raluca TOMOAIA ◽  
Ruxandra BEYER ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Systolic Function ◽  
Laboratory Data ◽  
Inflammatory Biomarkers ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Rehabilitation Programs ◽  
St Segment

Introduction: In spite of the enormous progress made over the last decades, acute coronary syndromes remain the leading cause of death globally. Inflammation plays an important role in coronary artery disease development. Although the role of inflammatory biomarkers in acute obstructive myocardial infarction is well established, there is no data regarding the potential differences between acute myocardial infarction (AMI) with ST segment elevation, AMI without ST segment elevation (NON-STEMI) and non-obstructive acute myocardial infarction (MINOCA), respectively. Also, it is well known that cardiac rehabilitation of acute myocardial infarction survivors significantly improves their long-term prognosis. Aim of the study: To asses the possible existing differences between patients with STEMI, NON-STEMI and MINOCA in terms of clinical and paraclinical parameters, especially inflammatory biomarkers. A second objective of our study was to describe the relationship between inflammatory, cardiac necrosis enzymes and left ventricle systolic function. Material and methods: The study included 35 adult patients admitted in the Cardiology service of the Niculae Stăncioiu Heart Institute, Cluj-Napoca with acute myocardial infarction. Demographic, clinical, echocardiographic and laboratory data were analyzed. Patients were divided into 3 groups, 19 patients (54.2%) were diagnosed with STEMI- group 1, 9 patients (25.7%) with NON-STEMI- group 2 and 7 patients (20%) with MINOCA- group 3, respectively. Dosage of serum inflammatory markers was performed on the day of admission. Results and conclusion: The most common associated cardiovascular risk factor was arterial hypertension (65.7% of patients). Markers of myocardial necrosis (CK, CK-MB, hs Troponin) were significantly higher in patients with STEMI (p <0.05) in comparison with NON-STEMI and MINOCA patients. Congestive heart failure was most frequently encountered in STEMI patients. hsCRP value was higher among patients with STEMI. The value of ESR was significantly higher among patients with NON-STEMI. Serial dosage of inflammation biomarkers in patients with recent acute myocardial infarction may serve as valuable risk stratification instruments and also for functional capacity and recovery status assessment in patients included in cardiac rehabilitation programs. Keywords: acute coronary syndrome; inflammatory biomarkers; non-obstructive acute myocardial infarction,

Approach to the Patient Presenting with Chest Pain

2017 ◽  
Author(s):  
John Tobias Nagurney
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pain History

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. The figure shows an algorithm outlining the approach to the patient with chest pain. Tables list critical and noncritical diagnoses in patients presenting with chest pain: history, physical examination, and bedside testing; risk factors or associations for acute coronary syndrome, pulmonary embolism, and aortic dissection; characteristics of the chest pain story to diagnose acute coronary syndrome; ABCDEs of resuscitation for patients with unstable vital signs; critical and noncritical diagnoses in patients presenting with chest pain: history, diagnosis, and treatment; prevalence of pulmonary embolism in patients classified as low or high probability for this diagnosis by Wells score, modified Geneva score, and gestalt; commonly recognized pitfalls in the workup and diagnosis of chest pain in the emergency department; critical diagnoses in patients presenting with chest pain: history, disposition, and outcome; and summary of current recommendations. This review contains 1 highly rendered figure, 11 tables, and 54 references. Key words: acute coronary syndrome, acute myocardial infarction, anginal pain, aortic dissection, cardiac-related pain, chest pain, coronary artery disease, non–ST segment elevation myocardial infarction, pulmonary embolism, ST segment elevation myocardial infarction

scholarly journals Outcomes in nonagenarians with acute coronary syndrome. Is medical treatment important?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
JULIO Echarte-Morales ◽  
ELENA Tundidor Sanz ◽  
E Martinez Gomez ◽  
PEDRO Cepas-Guillen ◽  
JAVIER Borrego Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Dual Antiplatelet Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up.  Purpose  The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction. Methods A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded.  Results  680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had a higher GRACE score compared to the conservative treatment group (177 versus 172; p = 0.001). Patients with ST-segment elevation myocardial infarction (STEMI) were more likely to receive an invasive strategy than the non-ST segment elevation myocardial infarction (NSTEMI) (61.5% versus 41.5%; p= 0.001). 263 patients died at 1 year follow up with in-hospital mortality of 17%. In STEMI group, patients with statins and dual antiplatelet therapy at discharge had lower mortality during follow up compared to those who did not received (26.7 % versus 41.5%; p = 0.001 and 31% versus 22%; p = 0.02, respectively) (Image 1).  Conclusions Nonagenarian patients with ACS have a high prevalence of hypertension and ICP procedures are not performed frequently. They also have a high mortality rate, although statins and dual antiplatelet therapy could be an effective secondary prevention. Abstract Figure.

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