Department of Medicine, Baylor College of Medicine, Houston, TX.
Department of Medicine, Baylor College of Medicine, Houston, TX.
Curr Probl Cardiol. 2023 Jan;48(1):101418. doi: 10.1016/j.cpcardiol.2022.101418. Epub 2022 Sep 28.
The clinical significance of right bundle branch block (RBBB) or bifascicular block (BFB) in the setting of acute myocardial infarction (AMI) is uncertain. RBBB was found in 211 of 7,626 patients (2.8%), presenting to the ED (emergency department) with chest pain, of which 18 (8.5%) also had acute coronary syndrome (ACS). Incidences of ACS were not significantly different between new or presumed new RBBB and prior known RBBB or new or presumed new BFB and prior known BFB. In 2 patients, baseline ST-segment depression in leads V1-3 masked anterior ST-elevation detected on electrocardiogram (ECG). In opposition to the guidelines, the presence of RBBB or BFB does not appear to offer any clinical utility when evaluating patients with suspected AMI. Patients with suspected AMI who present with RBBB and any ST-elevation in leads V1-3 should be considered for emergent coronary angiography rather than RBBB alone.
在急性心肌梗死（AMI）的情况下，右束支传导阻滞（RBBB）或双分支阻滞（BFB）的临床意义尚不确定。在因胸痛就诊于急诊科（ED）的 7626 名患者中，发现有 211 名（2.8%）患者存在 RBBB，其中 18 名（8.5%）患者还伴有急性冠状动脉综合征（ACS）。新发或疑似新发 RBBB 与既往已知 RBBB 或新发或疑似新发 BFB 与既往已知 BFB 患者 ACS 的发生率无显著差异。在 2 名患者中，基线 ST 段压低在 V1-3 导联中掩盖了心电图（ECG）上检测到的前侧壁 ST 抬高。与指南相反，当评估疑似 AMI 患者时，RBBB 或 BFB 的存在似乎没有任何临床意义。对于怀疑患有 AMI 且存在 RBBB 且 V1-3 导联任何 ST 段抬高的患者，应考虑进行紧急冠状动脉造影，而不仅仅是 RBBB。
