Left bundle branch block with acute anteroseptal myocardial infarction in 1 case of rapid diagnosis and treatment
[Keywords:] left bundle branch block in acute myocardial infarction rapid diagnosis and treatment of anteroseptal
A medical record
Patients, male, 56 years old. Because of sudden chest pain and rushed to hospital by ambulance 20min .20 min before the unexpected when at rest in patients with chest pain and sustained, self-serving HMP no relief. Past hypertension,
hyperlipidemia, crown cardiac history, electrocardiogram had showed complete left bundle branch block (LBBB). checkup: T 36.4 ??, P 96 times / min, BP 148/86mmHg (1mmHg = 0.133kPa), jugular vein without filling, lungs is not known and the wet and dry rales, no increased heart dullness, heart sounds normal, regular rhythm, no murmur of the valve area, peripheral vascular sign was negative. electrocardiogram showed: LBBB, V1, 2 showed a QS wave ECG, ST segment depression 0.15 mV, V3 lead ST segment depression 0.05mV, V1,
2 lead T wave low-lying, V4 ~ 6ST lower segment and T wave inversion. troponin (CTnI) 1.6ng / L, creatine kinase isoenzyme ( CK-MB) is normal. diagnosis of acute anteroseptal myocardial infarction.
2.1 newly issued identification LBBB LBBB and the original
Left bundle branch and short thick trunk, the trunk of the first half of the interventricular septum from the left anterior descending artery before the artery, usually the latter part of the trunk of the atrioventricular node in the
right coronary artery and right descending coronary issued after the room After the interval artery. LBBB in AMI rate was 5% of patients, mainly in the anterior myocardial infarction, the development of RBBB ?? degree AVB were less than, but the
mortality and the right bundle branch block (RBBB) and Other
double-bundle branch block as high. What is acute myocardial infarction (AMI) associated with LBBB or existing LBBB, mainly rely on the original history and electrocardiogram. distinguish between the purpose of judging the severity of disease is extremely important. this case the original ECG show that the existence of patients with previous LBBB.
2.2 LBBB in acute myocardial infarction when the shape of
ECG diagnosis of AMI can provide fast and direct evidence,
and often decisive diagnosis. LBBB, the ventricular activation mainly constituted by the three vectors, followed by the right ventricular septum, left ventricular septal and left ventricular free wall. The three vectors by right to left, QRS
vector loop is significantly offset to the left, and ST-T and
its opposite, and the resulting QRS and ST-T changes: (1) V1,
2 showed a QS or rS, ??, aVF showed QS waves group; (2) V4 ~ 6, I, aVR was no q wave and R wave, and no S wave; (3) LBBB
often secondary ST-T changes, all the basic graphics in the QRS-up leads, such as V4 ~ 6, I, aVR, ST segment depression and showed significant T wave inversion, QRS graphics in the basic down leads, showed mild ST segment elevation and T wave upright. Because of these changes, especially ST-T change,
leading to changes in AMI's graphics are not typical, so that the AMI diagnosis is difficult, especially when painless AMI. Therefore, patients with suspected AMI ECG changes should be read carefully to find clues to the diagnosis of AMI.
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2.3 when acute myocardial infarction with LBBB ECG leads
LBBB with AMI or AMI with LBBB, the following changes suggestive of AMI: (1) Where the basic upward QRS graphics
appear in lead ST segment elevation has not even dropped, T-
wave inversion, while the basic upward graph in the QRS in lead ST segment elevation but not lower, T wave upright; (2) V4 ~ 6, I, aVR appeared q wave; (3) V1, 2 r appears significant wave; (4) ECG showed dynamic ST-T changes. The
case V1, 2 should be manifested as ST-T elevation, but in fact
decreased, T wave should be inverted was presented as flat, acute myocardial infarction as an important diagnostic clues.
2.4 Diagnostic difficulties in the diagnosis and treatment
strategies should take timely
With suspected AMI and ECG diagnosis of AMI clues shall immediately underwent coronary angiography to confirm the diagnosis as soon as possible and timely implementation of the stent implantation. If stenting is limited, or more than the time window to thrombolytic therapy immediately . without ECG diagnostic clues and highly suspected AMI, we should closely observe the dynamic changes in ECG and cardiac injury markers Jicha. As with the coronary stent implantation and the
efficacy of thrombolytic therapy to improve the prognosis is closely related with the time, so should seize the time, early diagnosis, so as not to delay the implementation of key measures.
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