scholarly journals An Unusual Cause of Concordance in the Setting of Left Bundle Branch Block

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Alqaisi O ◽  
◽  
Carter J ◽  
Xu J ◽  
Paydak H ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Normal Sinus Rhythm ◽  
International Normalized Ratio ◽  
Verbal Response ◽  
Sensory Loss ◽  
Initial Examination ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Normal Sinus ◽  
Glascow Coma Scale

A 73-year-old female with a past medical history of atrial fibrillation, mechanical mitral valve replacement on warfarin, hypertension and hypothyroidism presented to the emergency department with a fall. She fell and hit her head upon standing up from a seated position. She reported a constant posteriorly located headache along with episodes of nausea and vomiting. She denied chest pain, shortness of breath, syncope and fever. The initial examination showed blood pressure of 107/64mmHg, respiratory rate of 13/Min, pulse of 76/Min, oxygen saturation of 96% and Glascow Coma Scale (GCS) of 13, verbal response 4, motor response 6 and eye response 3. Pupils were round and reactive to light. No focal weakness or sensory loss were noted. The patient’s mental status and GCS progressively worsened for which she eventually was intubated. The patient had a mild leukocytosis of 14.11×109 (4.0-10.0). Her sodium, calcium, magnesium, phosphorus and potassium were normal. International Normalized Ratio (INR) was 2.9. The troponin upon presentation was 0.69ng/ml and trended down throughout the hospitalization. Her EKG showed normal sinus rhythm with a left bundle branch block with ST segment elevation in leads V3 - V5 and concordant ST elevation >1mm in V5. Sgarbossa criteria for acute myocardial infarction in the presence of LBBB was 5 points. Computed tomography (CT) scan of the head without contrast showed large bilateral cerebellar hemorrhages with mild inferior herniation of the cerebellar tonsils. Echocardiogram showed ejection fraction of 55-60% with no wall motion abnormalities. Immediate supportive treatment, including fluids and reversal of anticoagulation with prothrombin complex concentrate and vitamin K were administered. The patient underwent a successful suboccipital decompressive craniotomy.

Left ventricular resynchronization therapy in a canine model of left bundle branch block

2002 ◽  
Vol 282 (6) ◽  
pp. H2238-H2244 ◽  
Author(s):  
Lili Liu ◽  
Bruce Tockman ◽  
Steven Girouard ◽  
Joseph Pastore ◽  
Greg Walcott ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Wall Motion ◽  
Normal Sinus Rhythm ◽  
Posterior Wall ◽  
Canine Model ◽  
Left Ventricular ◽  
Pressure Derivative ◽  
Bundle Branch Block ◽  
Normal Sinus ◽  
Before And After

Positive responses to left (LV) and biventricular (BV) stimulation observed in heart failure patients with left bundle branch block (LBBB) suggest a possible mechanism of LV resynchronization. An anesthetized canine LBBB model was developed using radio frequency ablation. Before and after ablation, LV pressure derivative over time (dP/d t) and aortic pulse pressure (PP) were assessed during normal sinus rhythm with right ventricle (RV), LV, or BV stimulation combined with four atrioventricular delays in six dogs. In three more dogs, M-mode echocardiograms of septal and LV posterior wall motion were obtained before and after LBBB and during LV stimulation. LBBB caused QRS widening and hemodynamics deterioration. Before ablation, stimulation alone worsened LV dP/d t and PP. After ablation, LV and BV stimulation maximally increased LV dP/d t by 16% and PP by 7% ( P < 0.001), whereas little improvement was observed during RV stimulation. M-mode echocardiogram showed that LBBB resulted in a paradoxical septal wall motion that was corrected by LV stimulation. In conclusion, LV and BV stimulation improved cardiac function in a canine LBBB model via resynchronization of LV excitation and contraction.

scholarly journals Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hugo De Carvalho ◽  
Lucas Leonard-Pons ◽  
Julien Segard ◽  
Nicolas Goffinet ◽  
François Javaudin ◽  
...  
Keyword(s):  
At Risk ◽  
Hospital Mortality ◽  
Left Bundle Branch Block ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Normal Sinus Rhythm ◽  
Outcome Data ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Ecg Abnormalities

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be associated with myocardial injury. Identification of at-risk patients and mechanisms underlying cardiac involvement in COVID-19 remains unclear. During hospitalization for COVID-19, high troponin level has been found to be an independent variable associated with in-hospital mortality and a greater risk of complications. Electrocardiographic (ECG) abnormalities could be a useful tool to identify patients at risk of poor prognostic. The aim of our study was to assess if specific ECGs patterns could be related with in-hospital mortality in COVID-19 patients presenting to the ED in a European country. Methods From February 1st to May 31st, 2020, we conducted a multicenter study in three hospitals in France. We included adult patients (≥ 18 years old) who visited the ED during the study period, with ECG performed at ED admission and diagnosed with COVID-19. Demographic, comorbidities, drug exposures, signs and symptoms presented, and outcome data were extracted from electronic medical records using a standardized data collection form. The relationship between ECG abnormalities and in-hospital mortality was assessed using univariate and multivariable logistic regression analyses. Results An ECG was performed on 275 patients who presented to the ED. Most of the ECGs were in normal sinus rhythm (87%), and 26 (10%) patients had atrial fibrillation/flutter on ECG at ED admission. Repolarization abnormalities represented the most common findings reported in the population (40%), with negative T waves representing 21% of all abnormalities. We found that abnormal axis (adjusted odds ratio: 3.9 [95% CI, 1.1–11.5], p = 0.02), and left bundle branch block (adjusted odds ratio: 7.1 [95% CI, 1.9–25.1], p = 0.002) were significantly associated with in-hospital mortality. Conclusions ECG performed at ED admission may be useful to predict death in COVID-19 patients. Our data suggest that the presence of abnormal axis and left bundle branch block on ECG indicated a higher risk of in-hospital mortality in COVID-19 patients who presented to the ED. We also confirmed that ST segment elevation was rare in COVID-19 patients.

Abstract 15474: New Onset Left Bundle Branch Block Secondary to Severe Hyperkalemia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmed H Qavi ◽  
Abdul M Minhas ◽  
Fariha Ilyas
Keyword(s):  
Left Bundle Branch Block ◽  
Normal Sinus Rhythm ◽  
New Left ◽  
Renal Diseases ◽  
Conduction Delay ◽  
Bundle Branch Block ◽  
Electrolyte Disturbances ◽  
Normal Sinus ◽  
Life Threatening ◽  
T Waves

Case presentation: A 79-year-old female with history of renal failure on hemodialysis (HD) presented with generalized weakness. Her last HD was 3 days ago. On examination, she was vitally stable. Blood tests demonstrated a potassium (K+) of 8.3 mmol/L, confirmed on repeat testing. ECG revealed wide QRS, tall T waves and a new left bundle branch block (Figure 1). She was immediately treated with calcium chloride, insulin, dextrose and polystyrene sulfonate. The patient was admitted to the ICU and underwent emergent HD. Repeat K+ post HD reversed to 4.0 mmol/L and ECG reflected normal sinus rhythm with resolution of ST-T wave changes (Figure 2). Discussion: Hyperkalemia can lead to cardiac arrhythmias and sudden death. The ECG changes are dependent on severity of hyperkalemia. It can vary from narrow based, peaked T waves to ventricular fibrillation. Hyperkalemia can also lead to interventricular conduction delays, which, with severity, can take the form of right or left bundle branch block (LLLB). The conduction delay from hyperkalemia usually lasts only in initial or terminal portions as opposed to throughout the QRS complex as seen in bundle branch block disease. Association of LLLB with hyperkalemia is an uncommon but important occurrence and has only scarcely been reported in literature. Its prevalence remains unknown. With the growing use of renin-angiotensin aldosterone system inhibitors, more patients are prone to experience life threatening electrolyte disturbances. A thorough knowledge of the ECG manifestations related to hyperkalemia is crucial to ensure emergent treatment. This may result in improved outcomes in such patients with cardiovascular and renal diseases.

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 Reperfusion in Patients With Renal Dysfunction After Presentation With ST-Segment Elevation or Left Bundle Branch Block

2009 ◽  
Vol 2 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Caroline Medi ◽  
Gilles Montalescot ◽  
Andrzej Budaj ◽  
Keith A.A. Fox ◽  
José López-Sendón ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
St Segment

Transient ST segment elevation and left bundle branch block caused by mad-honey poisoning

2012 ◽  
Vol 124 (7-8) ◽  
pp. 278-281 ◽  
Author(s):  
Muhammet Rasit Sayin ◽  
Turgut Karabag ◽  
Sait Mesut Dogan ◽  
Ibrahim Akpinar ◽  
Mustafa Aydin
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
St Segment ◽  
Mad Honey

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.

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