Transitory R wave growth in the midst of ST-segment elevation myocardial infarction: A case of left septal fascicular
1Department of Cardiology, Limassol General Hospital, Limassol, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus.
Insights
This case study highlights a patient with left anterior descending artery occlusion experiencing angina. The study details the diagnosis of left septal fascicular block (LSFB) on ECG, even with atypical features.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Acute coronary syndromes, such as myocardial infarction, can present with complex electrocardiographic (ECG) findings.
- Left septal fascicular block (LSFB) is a rare conduction abnormality that can mimic other cardiac conditions.
- Accurate ECG interpretation is crucial for timely diagnosis and management of cardiac emergencies.
Observation:
- A patient presented with angina and ST-segment elevation, indicative of proximal left anterior descending coronary artery occlusion.
- Serial ECGs revealed findings consistent with left septal fascicular block (LSFB).
- The LSFB was observed alongside a pre-existing left anterior fascicular block, presenting with atypical ECG features.
Findings:
- The patient exhibited intermittent prominent anterior QRS forces (R wave) solely in lead V2.
- Preserved septal q waves were noted in leads I and aVL, which is atypical for standard LSFB.
- This case underscores the variability in ECG presentation of LSFB, particularly when co-occurring with other conduction abnormalities.
Implications:
- Understanding the diagnostic criteria for LSFB is essential for correct interpretation of complex ECGs.
- Atypical ECG presentations of LSFB can arise due to various factors, including co-existing conduction defects.
- This case contributes to the literature on recognizing rare fascicular blocks in the context of acute coronary syndromes.
Abstract:
We report the case of a patient who presented with angina and ST-segment elevation in the precordial leads owing to a proximal occlusion of the left anterior descending coronary artery. Serial electrocardiography (ECG) showed signs consistent with the left septal fascicular block (LSFB). The latter was observed in conjunction with a pre-existing left anterior fascicular block and presented atypical ECG features, such as intermittent prominent anterior QRS forces (prominent R wave) in V2 only and preserved septal q waves in I and aVL. In the discussion, we present an overview of the electrocardiographic criteria for the diagnosis of the LSFB together with reasons for which LSFB may present with an atypical ECG picture.
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