[Pictures of the fascicular block inacute myocardial infarct with special reference to left anterior hemiblock and the bifascicular block of the anterior type].

In the etiology of uni, bi- and trifascicular block pictures the acute myocardial infarction plays an important role. From the topographic relations of the supply of coronary vessels to the coduction system certain correlations between localisation of infarction and kind of blocking are to be explained. The electrocardiographic changes of the individual block pictures are explained. 765 (581 males, 184 females) patients with acute myocardial infarction were examined concerning frequency and prognosis of the left anterior hemiblock and the bifascular block of anterior type (left anterior hemiblock, right bundle branch block). A left anterior hemiblock could be proved in 90 cases (11.8%), a bifascicular block of anterior type in 38 cases (5%). With 30% the lethality of the first group was not essentially above the lethality of patients with infarction without block pictures (29.6%). In patients with bifascicular block of anterior type it was significantly incrased with 68.4%. The two block forms were nearly exclusively found in the anterior wall infarction and its combination with a posterior wall infarction, respectively. 11 patients, out of whom 9 died, showed a transition of the bifascicular block into a trifascicular one. In 6 cases a left anterior hemiblock had preceded. The results concerning frequency and prognosis much correspond with the reports of other authors. In the bifascicular block, apart from the danger of a sudden asystolia, also the most cases larger size of the extension of the infarction with the adequately higher risk of a muscular insuficiency might be responsible for the bad prognosis. The therapeutic possibilities and necessities deriving from this are explained.