Cargando…

Left Bundle Branch Block Chest Pain Conundrum

Left bundle branch block is a pattern of altered ventricular depolarization and subsequently affects repolarization. These obscure patterns can affect the traditional ST segment shift criteria for the electrocardiographic detection of coronary insufficiency syndromes. Previously, patients with coron...

Descripción completa

Detalles Bibliográficos
Autores principales: Seetharam, Karthik, Cheema, Ayesha, Friedman, Gary, Pachulski, Roman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053445/
https://www.ncbi.nlm.nih.gov/pubmed/32148969
http://dx.doi.org/10.1155/2020/2724981
_version_ 1783503041270382592
author Seetharam, Karthik
Cheema, Ayesha
Friedman, Gary
Pachulski, Roman
author_facet Seetharam, Karthik
Cheema, Ayesha
Friedman, Gary
Pachulski, Roman
author_sort Seetharam, Karthik
collection PubMed
description Left bundle branch block is a pattern of altered ventricular depolarization and subsequently affects repolarization. These obscure patterns can affect the traditional ST segment shift criteria for the electrocardiographic detection of coronary insufficiency syndromes. Previously, patients with coronary ischemic pain and LBBB judged to be “new” (not previously documented) were considered to have ST elevation myocardial infarction (STEMI) warranting acute thrombolytic therapy. Current STEMI management favors emergent invasive angiography; however, recent data suggests the prevalence of coronary obstructive pathology may be as low as 50%. The application of more specific, less-sensitive Sgarbossa electrocardiographic criteria may reduce angiographic assessment in an otherwise high-risk population unlikely to tolerate further myocardial injury. We present a case that may facilitate a more nuanced EKG-based approach to distinguish those who may benefit from acute invasive angiography while reducing the frequency of unnecessary angiographic evaluation.
format Online
Article
Text
id pubmed-7053445
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-70534452020-03-06 Left Bundle Branch Block Chest Pain Conundrum Seetharam, Karthik Cheema, Ayesha Friedman, Gary Pachulski, Roman Case Rep Cardiol Case Report Left bundle branch block is a pattern of altered ventricular depolarization and subsequently affects repolarization. These obscure patterns can affect the traditional ST segment shift criteria for the electrocardiographic detection of coronary insufficiency syndromes. Previously, patients with coronary ischemic pain and LBBB judged to be “new” (not previously documented) were considered to have ST elevation myocardial infarction (STEMI) warranting acute thrombolytic therapy. Current STEMI management favors emergent invasive angiography; however, recent data suggests the prevalence of coronary obstructive pathology may be as low as 50%. The application of more specific, less-sensitive Sgarbossa electrocardiographic criteria may reduce angiographic assessment in an otherwise high-risk population unlikely to tolerate further myocardial injury. We present a case that may facilitate a more nuanced EKG-based approach to distinguish those who may benefit from acute invasive angiography while reducing the frequency of unnecessary angiographic evaluation. Hindawi 2020-02-19 /pmc/articles/PMC7053445/ /pubmed/32148969 http://dx.doi.org/10.1155/2020/2724981 Text en Copyright © 2020 Karthik Seetharam et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Seetharam, Karthik
Cheema, Ayesha
Friedman, Gary
Pachulski, Roman
Left Bundle Branch Block Chest Pain Conundrum
title Left Bundle Branch Block Chest Pain Conundrum
title_full Left Bundle Branch Block Chest Pain Conundrum
title_fullStr Left Bundle Branch Block Chest Pain Conundrum
title_full_unstemmed Left Bundle Branch Block Chest Pain Conundrum
title_short Left Bundle Branch Block Chest Pain Conundrum
title_sort left bundle branch block chest pain conundrum
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053445/
https://www.ncbi.nlm.nih.gov/pubmed/32148969
http://dx.doi.org/10.1155/2020/2724981
work_keys_str_mv AT seetharamkarthik leftbundlebranchblockchestpainconundrum
AT cheemaayesha leftbundlebranchblockchestpainconundrum
AT friedmangary leftbundlebranchblockchestpainconundrum
AT pachulskiroman leftbundlebranchblockchestpainconundrum