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A Case With Inferior Wall Myocardial Infarction and Conduction Abnormalities: Addressing the Diagnostic Challenges

Dinkar Bhasin1, Rahul Kumar2, Tushar Agarwal2

  • 1Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.

Cureus
|May 4, 2022
PubMed

Insights

Conduction disturbances complicate ST-elevation myocardial infarction (STEMI). This case highlights challenges diagnosing myocardial infarction (MI) with right bundle branch block (RBBB) and left anterior hemiblock (LAHB).

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • Conduction disturbances, including fascicular and bundle branch blocks, are significant complications of ST-elevation myocardial infarction (STEMI).
  • These disturbances alter QRS morphology and ST-T wave patterns, potentially complicating the diagnosis of acute myocardial ischemia.
  • Accurate diagnosis of myocardial infarction (MI) is crucial for timely and effective patient management.

Observation:

  • A case is presented involving a patient with inferior wall myocardial infarction (MI).
  • The patient exhibited a right bundle branch block (RBBB) and a left anterior hemiblock (LAHB) concurrently.
  • This combination of conduction abnormalities presented diagnostic challenges.

Findings:

  • Right bundle branch block (RBBB) and left anterior hemiblock (LAHB) significantly alter the electrocardiogram (ECG) QRS morphology.
  • These QRS changes can obscure or mimic signs of acute myocardial ischemia, particularly STEMI.
  • Differentiating between combined first-degree atrioventricular (AV) block with bifascicular block and trifascicular block is complex in this setting.

Implications:

  • The presence of RBBB and LAHB necessitates careful interpretation of ECG findings during suspected MI.
  • Advanced diagnostic strategies may be required to confirm or exclude MI in patients with complex conduction disturbances.
  • Understanding these ECG patterns is vital for cardiologists to avoid misdiagnosis and ensure appropriate treatment for STEMI.

Keywords:
acute coronary syndromebifascicular blockbundle branch blockconduction disturbancesstemisystemic thrombolysistrifascicular block

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