Brady W J, Aufderheide T P
Department of Emergency Medicine, University of Virginia, School of Medicine, Charlottesville, USA.
Acad Emerg Med. 1997 Jan;4(1):56-62. doi: 10.1111/j.1553-2712.1997.tb03644.x.
The ECG diagnosis of ischemic heart disease is made more difficult in the setting of left bundle branch block (LBBB). The ECG diagnosis of prior or remote myocardial infarction (MI) is extremely difficult in this setting. Furthermore, the associated--and expected--ST-segment--T-wave abnormalities of LBBB may mimic acute ischemic change. However, ECG detection of abnormalities arising from acute ischemic cardiac disease in the setting of LBBB can be valuable. Several strategies are available to the emergency physician (EP) to assist in the correct interpretation of this ECG pattern, including: a knowledge of the anticipated ST-segment--T-wave changes of LBBB and, consequently, the ability to recognize ischemic morphologies; the performance of serial ECGs demonstrating dynamic changes encountered in ischemic patients; and a comparison with previous ECGs. Three cases are reported in which an analysis of the 12-lead ECG in the setting of LBBB assisted the EP in establishing the correct diagnosis of acute MI and applying timely, appropriate therapy.
在左束支传导阻滞（LBBB）的情况下，缺血性心脏病的心电图诊断变得更加困难。在此情况下，既往或陈旧性心肌梗死（MI）的心电图诊断极其困难。此外，LBBB相关的且预期会出现的ST段-T波异常可能会酷似急性缺血性改变。然而，在LBBB情况下对急性缺血性心脏病引起的异常进行心电图检测可能是有价值的。急诊医生（EP）有几种策略可用于协助正确解读这种心电图模式，包括：了解LBBB预期的ST段-T波变化，从而能够识别缺血性形态；进行系列心电图检查以显示缺血患者中遇到的动态变化；以及与以前的心电图进行比较。报告了三例病例，其中对LBBB情况下的12导联心电图进行分析，协助急诊医生正确诊断急性心肌梗死并及时应用适当的治疗。
