Rosner M H, Brady W J
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, USA.
Am J Emerg Med. 1998 Nov;16(7):697-700. doi: 10.1016/s0735-6757(98)90180-2.
The electrocardiographic diagnosis of ischemic heart disease is made more difficult in the setting of confounding patterns, including left bundle branch block (LBBB). The electrocardiographic detection of abnormalities arising from acute ischemic cardiac disease in this setting is possible in certain cases, contrary to popular medical opinion. Several strategies are available to assist in the correct interpretation of the electrocardiogram (ECG) with LBBB and potential acute ischemia, including: (1) a knowledge of the anticipated ST segment-T wave morphologies of LBBB and, consequently, the ability to recognize ischemic changes; (2) the performance of serial ECGs demonstrating dynamic change; and (3) a comparison to previous ECGs. The first strategy, an awareness of the anticipated ST segment morphologies of LBBB, is the most important and not dependent on additional diagnostic testing or past medical records.
在存在包括左束支传导阻滞（LBBB）等混淆模式的情况下，缺血性心脏病的心电图诊断变得更加困难。与普遍的医学观点相反，在这种情况下，某些病例有可能通过心电图检测出急性缺血性心脏病引起的异常。有几种策略可用于协助正确解读伴有LBBB和潜在急性缺血的心电图（ECG），包括：（1）了解LBBB预期的ST段 - T波形态，从而能够识别缺血性改变；（2）进行系列心电图检查以显示动态变化；（3）与既往心电图进行比较。第一种策略，即了解LBBB预期的ST段形态，是最重要的，且不依赖于额外的诊断测试或既往病历。
