Piedmont Athens Regional Internal Medicine Residency Program, Athens, Georgia, USA
Piedmont Athens Regional Internal Medicine Residency Program, Athens, Georgia, USA.
BMJ Case Rep. 2023 Dec 28;16(12):e254953. doi: 10.1136/bcr-2023-254953.
Masquerading bundle branch block is an easily overlooked pattern on the ECG that indicates severe disease of the atrioventricular nodal conduction pathway. It is often caused by coronary artery disease, infiltrative diseases of the heart and idiopathic degeneration of the atrioventricular nodal conduction pathways. The diagnosis is easily missed as it needs a detailed interpretation of the ECG in addition to the clinical presentation of the patient. The presence of this specific bundle branch block pattern on the ECG indicates severe degeneration of the conduction system requiring intervention. Given its rarity, this clinical entity risks misdiagnosis and inappropriate management. This case highlights two diagnostic challenges for clinicians: the rarely described masquerading bundle branch block and the art of clinically differentiating between epilepsy and convulsive syncope.
伪装性束支传导阻滞是心电图上一种容易被忽视的模式，表明房室结传导通路严重疾病。它通常由冠状动脉疾病、心脏浸润性疾病和特发性房室结传导通路退行性变引起。由于需要结合患者的临床表现对心电图进行详细解读，因此很容易漏诊。心电图上存在这种特定的束支传导阻滞模式表明传导系统严重退化，需要干预。由于其罕见性，这种临床实体存在误诊和不当治疗的风险。本病例为临床医生提出了两个诊断挑战：很少描述的伪装性束支传导阻滞和在癫痫和惊厥性晕厥之间进行临床鉴别诊断的艺术。
