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Acute myocardial infarction and left bundle branch block with changing axis deviation

Salvatore Patanè, Filippo Marte, Giuseppe Dattilo

    International Journal of Cardiology
    |May 8, 2009
    PubMed

    Insights

    This study presents a rare case of left bundle branch block with changing axis deviation in an elderly patient experiencing acute myocardial infarction. The findings suggest a potential coexistence of left posterior hemiblock and predivisional left bundle branch block.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Medical Diagnostics

    Background:

    • Changing axis deviation is observed in various cardiac conditions, including atrial fibrillation, atrial flutter, and acute myocardial infarction.
    • Left bundle branch block (LBBB) typically presents with normal or left axis deviation on electrocardiograms (ECGs).

    Observation:

    • This case report details a rare instance of LBBB exhibiting changing QRS morphology and axis deviation.
    • The patient was a 93-year-old Italian woman admitted with acute myocardial infarction.

    Findings:

    • The intermittent shift in the QRS axis in the presence of complete LBBB suggests complex underlying electrical conduction abnormalities.
    • The most plausible explanation identified is the coexistence of left posterior hemiblock and predivisional left bundle branch block.

    Implications:

    • Understanding these rare ECG presentations is crucial for accurate diagnosis and management of complex cardiac events.
    • This case highlights the importance of considering combined conduction defects in patients with LBBB and dynamic ECG changes.

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