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New Right Bundle Branch Block as a Criterion for Emergent Coronary Angiography

Jonah M Pozen1, Anit K Mankad2, John T Owens3

  • 1Department of Internal Medicine and Cardiology, Virginia, USA.

North American Journal of Medical Sciences
|March 5, 2016
PubMed

Insights

New right bundle branch block (RBBB) on ECG in patients with chest pain may indicate acute myocardial infarction (AMI). This finding warrants consideration for urgent cardiac catheterization, potentially improving diagnostic sensitivity for AMI.

Area of Science:

  • Cardiology
  • Diagnostic Imaging

Background:

  • ST-segment elevation or new left bundle branch block (LBBB) on ECG are standard criteria for acute myocardial infarction (AMI) and prompt urgent cardiac catheterization.
  • The diagnostic significance of new right bundle branch block (RBBB) in isolation remains unclear and is not currently a criterion for emergent intervention.

Observation:

  • A case of acute myocardial infarction (AMI) is presented in a patient with chest pain, elevated cardiac biomarkers, and isolated new right bundle branch block (RBBB) on ECG.
  • The patient did not receive immediate reperfusion therapy due to the absence of ST-elevation or LBBB, despite the diagnosis of AMI.

Findings:

  • Coronary angiography revealed complete coronary artery occlusion in the patient.
  • This case highlights a potential underdiagnosis of AMI when only new RBBB is present.

Implications:

  • Including new RBBB in diagnostic criteria for AMI could enhance the sensitivity of established guidelines for emergent cardiac catheterization.
  • Revising current diagnostic protocols may lead to earlier intervention for a broader range of AMI patients.
Abstract

Keywords:
Cardiac catheterizationcoronary angiographymyocardial infarctionpercutaneous coronary interventionright bundle branch block

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