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Related Experiment Videos

Detecting exercise-induced ischemia in left bundle branch block using the electrocardiogram

N S Ibrahim1, G Abboud, R S Selvester

  • 1Memorial Heart Institute, Long Beach, California 90801, USA.

The American Journal of Cardiology
|October 7, 1998
PubMed
Summary
This summary is machine-generated.

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Electrocardiographic changes during exercise can identify coronary artery obstruction in patients with left bundle branch block. Specifically, ST depression in leads II and AVF and increased R-wave amplitude in lead II are significant indicators of ischemia.

Area of Science:

  • Cardiology
  • Diagnostic Imaging

Background:

  • Left bundle branch block (LBBB) can complicate exercise electrocardiography interpretation.
  • Accurate diagnosis of coronary artery disease (CAD) in LBBB patients is clinically important.

Purpose of the Study:

  • To identify specific 12-lead electrocardiographic (ECG) changes during exercise that reliably indicate significant coronary artery obstruction in patients with LBBB.

Main Methods:

  • Compared exercise ECG findings in 41 patients with LBBB.
  • Patients were categorized into nonischemic (n=7) and those with significant coronary artery obstruction (>=70% by angiogram, n=34).
  • Analyzed ST depression at the J point and R-wave amplitude changes in specific leads.

Main Results:

Related Experiment Videos

  • ST depression of >=0.5 mm from baseline at the J point in leads II and AVF significantly identified ischemia (p=0.004).
  • An increase in R-wave amplitude in lead II also significantly correlated with ischemia (p=0.05).

    • Conclusions:

    • Exercise-induced ST depression in leads II and AVF and increased R-wave amplitude in lead II are valuable indicators of significant coronary artery obstruction in patients with LBBB.
    • These ECG findings can aid in diagnosing ischemia in this challenging patient population.