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Posterior myocardial infarction and complete right bundle- branch block.
John E Madias1, Demetrius Bravidis, Mehran Attari
1Division of Cardiology, Elmhurst Hospital Center, and the Mount Sinai School of Medicine of the New York University, New York, NY 11373, USA. madiasj@nychhc.org
Chest
|November 12, 2002
Summary
This study highlights how electrocardiograms (ECG) can detect posterior myocardial infarction (PMI), even with atypical presentations. Specific ECG changes in right bundle-branch block (RBBB) patterns can indicate PMI, aiding diagnosis.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Posterior myocardial infarction (PMI) is often underdiagnosed, especially with atypical clinical presentations.
- Right bundle-branch block (RBBB) can complicate the electrocardiogram (ECG) interpretation in myocardial infarction.
- Atrioventricular (AV) block and mitral regurgitation are potential complications of myocardial infarction.
Observation:
- Two patients presented with atypical PMI, exhibiting complete AV block and Mobitz II second-degree AV block with higher degrees.
- Both patients had RBBB (new or old), with altered patterns including tall R and T waves in right precordial leads.
- These ECG alterations in RBBB were attributed to the superimposed effects of PMI on depolarization and repolarization.
Findings:
- The study identified specific ECG modifications in RBBB patterns indicative of PMI.
- These modifications include tall R waves in the early QRS and tall T waves in right precordial leads.
- The findings suggest PMI can alter the characteristic RBBB ECG pattern.
Implications:
- ECG is crucial for diagnosing PMI, particularly in complex or atypical cases.
- Recognizing these specific ECG changes can improve the early detection of PMI.
- This diagnostic insight is vital for timely management and improving patient outcomes in myocardial infarction.