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Ischemic blocks during early phase of anterior myocardial infarction: Correlation with st‐segment shift
Author(s) -
Sclarovsky S.,
Sagie A.,
Strasbero B.,
Shnapick Y.,
Rechavia E.,
Kusniec J.,
Agmon J.
Publication year - 1988
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960111107
Subject(s) - medicine , myocardial infarction , cardiology , cardiogenic shock , st segment , bundle branch block , incidence (geometry) , electrocardiography , atrioventricular block , pr interval , heart block , qrs complex , infarction , heart rate , physics , blood pressure , optics
Of 760 consecutive cases with anterior acute myocardial infarction (AMI), 55 developed acute bundle‐branch block (BBB), fascicular block, or high‐degree atrioventricular block during the hyperacute ECG stage of AMI. According to the direction of the ST segment during the acute ischemic episode, patients were divided into two groups. Group A consisted of 32 patients who developed BBB during ST‐segment elevation, positive T wave, and absent or minimal Q wave. Group B consisted of 23 patients who developed BBB during ST‐segment depression and evolved into anterior AMI. Group A was characterized by a higher incidence of right BBB and left anterior hemiblock [91% vs. 26% and 56% vs. 13%, respectively (p<0.005)]. Group B was characterized by a higher incidence of left BBB and left posterior hemiblock [57% vs. 9% and 26% vs. 12%, respectively (p<0.001)]. The BBB was transient (disappearing within hours to one day) in 14 patients in Group A and in 5 patients in Group B. The incidence of progression to high‐degree atrioventricular block was almost equal in the two groups (25% and 26%). The mortality rate was very high in both groups, but higher in Group B [74% vs. 59% (p=NS)] especially in those with LBBB (85%). Most patients died on the day of occurrence of BBB [Group A, 50% vs. Group B, 70% (p=NS)]. The causes of death in both groups were cardiogenic shock and/or electromechanical dissociation. It is concluded that there is a correlation between the ECG pattern of ST‐segment shift and the type of BBB, and that cardiac mortality is very high in this group of patients, especially in those with ST‐segment depression and left BBB.

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