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Medline ® Abstracts for References 1-5

of 'Electrocardiographic diagnosis of myocardial infarction in the presence of bundle branch block or a paced rhythm'

1
 
 
Goldberger AL, Goldberger ZA, Shvilkin A. Goldberger's clinical electrocardiography: A simplified approach, 9th, Elsevier/Saunders, Philadelphia 2017.
 
no abstract available
2
TI
The diagnosis of myocardial infarction in the presence of left bundle branch block.
AU
Wackers FJ
SO
Cardiol Clin. 1987;5(3):393.
 
Our analysis confirms the limited value of the electrocardiogram for the diagnosis of acute myocardial infarction in the presence of complete left bundle branch block. The various electrocardiographic criteria that have been proposed in the past as indicators of myocardial infarction lack sensitivity and predictive accuracy. In addition, they are subject to considerable inter-observer variability. In order of decreasing sensitivity, the following electrocardiographic criteria may be of diagnostic value: (1) serial changes of QRS complex or ST segment (sensitivity, 67 per cent); (2) ST segment elevation (sensitivity, 54 per cent; for anteroseptal infarction, 76 per cent); (3) abnormal Q waves (sensitivity, 31 per cent; for anteroseptal infarction, 53 per cent; highly specific: appearance of RV1, Qv6); and (4) sign of Cabrera (sensitivity, 27 per cent, for anteroseptal infarction, 47 per cent).
AD
Cardiovascular Nuclear Imaging Laboratory, Yale University School of Medicine, New Haven, Connecticut.
PMID
3
TI
Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators.
AU
Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, Topol EJ, Califf RM, Wagner GS
SO
N Engl J Med. 1996;334(8):481.
 
BACKGROUND: The presence of left bundle-branch block on the electrocardiogram may conceal the changes of acute myocardial infarction, which can delay both its recognition and treatment. We tested electrocardiographic criteria for the diagnosis of acute infarction in the presence of left bundle-branch block.
METHODS: The base-line electrocardiograms of patients enrolled in the GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) trial who had left bundle-branch block and acute myocardial infarction confirmed by enzyme studies were blindly compared with the electrocardiograms of control patients who had chronic coronary artery disease and left bundle-branch block. The electrocardiographic criteria for the diagnosis of infarction were then tested in an independent sample of patients presenting with acute chest pain and left bundle-branch block.
RESULTS: Of 26,003 North American patients, 131 (0.5 percent) with acutemyocardial infarction had left bundle-branch block. The three electrocardiographic criteria with independent value in the diagnosis of acute infarction in these patients were an ST-segment elevation of 1 mm or more that was concordant with (in the same direction as) the QRS complex; ST-segment depression of 1 mm or more in lead V1, V2, or V3; and ST-segment elevation of 5 mm or more that was disconcordant with (in the opposite direction from) the QRS complex. We used these three criteria in a multivariate model to develop a scoring system (0 to 10), which allowed a highly specific diagnosis of acute myocardial infarction to be made.
CONCLUSIONS: We developed and validated a clinical prediction rule based on a set of electrocardiographic criteria for the diagnosis of acute myocardial infarction in patients with chest pain and left bundle-branch block. The use of these criteria, which are based on simple ST-segment changes, may help identify patients with acute myocardial infarction, who can then receive appropriate treatment.
AD
Cleveland Clinic Foundation, Department of Cardiology, OH 44195, USA.
PMID
4
TI
Acute myocardial infarction and left bundle-branch block--can we lift the veil?
AU
Wellens HJ
SO
N Engl J Med. 1996;334(8):528.
 
AD
PMID
5
TI
Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. GUSTO-I investigators.
AU
Sgarbossa EB, Pinski SL, Gates KB, Wagner GS
SO
Am J Cardiol. 1996;77(5):423.
 
AD
The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
PMID