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Titolo:
Value of the ECG in suspected acute myocardial infarction with left bundlebranch block
Autore:
Sgarbossa, EB;
Indirizzi:
Rush Presbyterian St Lukes Med Ctr, Dept Cardiol, Chicago, IL 60612 USA Rush Presbyterian St Lukes Med Ctr Chicago IL USA 60612 ago, IL 60612 USA
Titolo Testata:
JOURNAL OF ELECTROCARDIOLOGY
, volume: 33, anno: 2000, supplemento:, S
pagine: 87 - 92
SICI:
0022-0736(2000)33:<87:VOTEIS>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRACTICE GUIDELINES COMMITTEE; ASSOCIATION TASK-FORCE; ELECTROCARDIOGRAPHIC DIAGNOSIS; CLINICAL CHARACTERISTICS; THROMBOLYTIC TREATMENT; ACC/AHA GUIDELINES; MANAGEMENT; THERAPY;
Keywords:
acute MI; LBBB; thrombolysis; cardiology guidelines;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Sgarbossa, EB Rush Presbyterian St Lukes Med Ctr, Dept Cardiol, 1750 W Harrison St, Chicago, IL 60612 USA Rush Presbyterian St Lukes Med Ctr 1750 W Harrison St Chicago IL USA 60612
Citazione:
E.B. Sgarbossa, "Value of the ECG in suspected acute myocardial infarction with left bundlebranch block", J ELCARDIOL, 33, 2000, pp. 87-92

Abstract

Uncomplicated left bundle branch block (LBBB) is characterized by true ST-segment shifts resulting from delayed repolarization in the left ventricle with respect to the right ventricle. When acute coronary occlusions developin the setting of previous or new LBBB. 12-lead eCG manifestations of injury may also appear. They consist of a more pronounced ST-sc gmc nt elevation, of ST-segment deviations opposite to those of uncomplicated LBBB, or both. We have reported that the only 3 independent ECG signs of acute MI during LBBB among patients with chest pain or history of coronary disease are: ST elevation greater than or equal to1 mm in leads with a positive QRS, ST-depression greater than or equal to1 mm in V1 to V3, and ST elevation greater than or equal to5 mm in leads with a negative QRS. In our study, the clinical prediction rule score values of these signs were 5; 3; and 2, respectively. A score greater than or equal to3 made a diagnosis of MI with a 90% specificity and a score of 2 with >80% specificity. Recent validation studies have confirmed that the presence of an) of these ECG signs is associated with a sensitivity of 44 to 79% and a specificity of 93 to 100%. Sensitivity increases if serial or previous ECGs are available for comparison. Interobserver agreement is very high. While current practice guidelines recommendthrombolysis for all patients with chest pain and LBBB, concern among physicians about hemorrhagic stroke prevents many of these patients from receiving timely treatment. In a population with LBBB and chest pain where our proposed ECG criteria were not ascertained, only 73% of eligible patients received thrombolysis; on the other hand, 48% of patients with no biochemical evidence of MI were thrombolyzed. For the latter group, the clinical prediction rule had a score of 0. Instead, 79% of patients with confirmed acute MI had a prediction rule score greater than or equal to2. Similar values applied to a subgroup of patients with serial ECGs. We propose that thrombolysis among patients with chest pain and LBBB be decided on the basis of a systematic ECG review to "rule patients in". This prc,vision may result in both a significant reduction in the number of patients without infarction who receive thrombolysis and in timely treatment of those who do have MI.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/04/20 alle ore 11:48:27