一例下壁心肌梗死合并传导异常病例：应对诊断挑战

A Case With Inferior Wall Myocardial Infarction and Conduction Abnormalities: Addressing the Diagnostic Challenges.

作者信息

Bhasin Dinkar, Kumar Rahul, Agarwal Tushar, Gupta Anunay, Bansal Sandeep

机构信息

Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.

Cardiology, Vardhman Mahavir Medical College, New Delhi, IND.

出版信息

Cureus. 2022 Mar 29;14(3):e23614. doi: 10.7759/cureus.23614. eCollection 2022 Mar.

DOI:10.7759/cureus.23614

PMID:35505748

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9053378/

Abstract

Conduction disturbances are an important complication of ST-elevation myocardial infarction (STEMI). Conduction disturbances such as fascicular blocks and bundle branch blocks are associated with alteration of QRS morphology and secondary ST-T wave changes that can influence the diagnosis of acute myocardial ischemia. We report an interesting case where a patient presented with inferior wall myocardial infarction (MI), right bundle branch block (RBBB), and left anterior hemiblock (LAHB). We discuss the challenges in diagnosing MI in such patients, including the impact of QRS changes in RBBB and LAHB, their influence on diagnosis of STEMI, and differentiation of combined first-degree AV block and bifascicular block from trifascicular block.

摘要

传导障碍是ST段抬高型心肌梗死（STEMI）的重要并发症。束支传导阻滞和分支传导阻滞等传导障碍与QRS波形态改变及继发性ST-T波改变相关，这些改变会影响急性心肌缺血的诊断。我们报告了1例有趣的病例，该患者表现为下壁心肌梗死（MI）、右束支传导阻滞（RBBB）和左前分支传导阻滞（LAHB）。我们讨论了在此类患者中诊断MI所面临的挑战，包括RBBB和LAHB中QRS波变化的影响、它们对STEMI诊断的影响，以及如何将合并的一度房室传导阻滞和双分支传导阻滞与三分支传导阻滞相鉴别。