Seetharam Karthik, Cheema Ayesha, Friedman Gary, Pachulski Roman
Division of Cardiology, St. John's Episcopal Hospital-South Shore, New York, New York, USA.
Case Rep Cardiol. 2020 Feb 19;2020:2724981. doi: 10.1155/2020/2724981. eCollection 2020.
Left bundle branch block is a pattern of altered ventricular depolarization and subsequently affects repolarization. These obscure patterns can affect the traditional ST segment shift criteria for the electrocardiographic detection of coronary insufficiency syndromes. Previously, patients with coronary ischemic pain and LBBB judged to be "new" (not previously documented) were considered to have ST elevation myocardial infarction (STEMI) warranting acute thrombolytic therapy. Current STEMI management favors emergent invasive angiography; however, recent data suggests the prevalence of coronary obstructive pathology may be as low as 50%. The application of more specific, less-sensitive Sgarbossa electrocardiographic criteria may reduce angiographic assessment in an otherwise high-risk population unlikely to tolerate further myocardial injury. We present a case that may facilitate a more nuanced EKG-based approach to distinguish those who may benefit from acute invasive angiography while reducing the frequency of unnecessary angiographic evaluation.
左束支传导阻滞是心室去极化改变的一种模式，随后会影响复极化。这些模糊的模式会影响用于心电图检测冠状动脉供血不足综合征的传统ST段偏移标准。以前，患有冠状动脉缺血性疼痛且左束支传导阻滞被判定为“新发”（以前未记录）的患者被认为患有ST段抬高型心肌梗死（STEMI），需要进行急性溶栓治疗。目前STEMI的治疗倾向于紧急侵入性血管造影；然而，最近的数据表明冠状动脉阻塞性病变的患病率可能低至50%。应用更具特异性、敏感性较低的斯加博萨心电图标准可能会减少对原本高风险、无法耐受进一步心肌损伤人群的血管造影评估。我们报告了一个病例，该病例可能有助于采用更细致入微的基于心电图的方法来区分哪些患者可能从急性侵入性血管造影中获益，同时减少不必要的血管造影评估频率。
