WIDE COMPLEX ECGs : case presentation

1,192 views
957 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,192
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
51
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

WIDE COMPLEX ECGs : case presentation

  1. 1. LEFT BUNDLE BRANCH BLOCK SYED RAZA
  2. 3. Prevalence <ul><li>0.2% of large population of US airforce personnel </li></ul><ul><li>0.6% of population recruited in Framingham Study ( average age 49 years) </li></ul><ul><li>1-2% in patients above 60 years </li></ul>
  3. 4. CAUSES OF LBBB <ul><li>Acute myocardial infarction (50%) </li></ul><ul><li>Underlying significant coronary artery disease </li></ul><ul><li>Aortic stenosis </li></ul><ul><li>Cardiomyopathy : DCM & HCM </li></ul><ul><li>Primary disease of the cardiac electrical conduction system </li></ul><ul><li>Long standing hypertension </li></ul>
  4. 5. Transient LBBB <ul><li>Tachycardia </li></ul><ul><li>Exercise induced </li></ul><ul><li>Acute pulmonary embolism </li></ul><ul><li>Heart failure </li></ul><ul><li>Coronary vessel fistula </li></ul>
  5. 6. Mechanism <ul><li>LBBB itself is related to heart rate acceleration. </li></ul><ul><li>When the heart rate quickens, the R-R interval becomes progressively shorter and a descending impulse may find the left bundle branch still in its refractory period. A “block” is then registered. </li></ul><ul><li>The rate at which conduction changes is called the “critical rate’’ </li></ul><ul><li>It will persist until the cycle lengthens enough for </li></ul><ul><li>normal conduction to occur. </li></ul>
  6. 7. CLINICAL IMPLICATION <ul><li>Complete cardiac evaluation as required </li></ul><ul><li>Basis for thrombolysis if new in presence of chest pain </li></ul><ul><li>Poor prognosis in patients of heart failure </li></ul><ul><li>Cause for inter ventricular dysynchrony and need for Bi-Ventricular pacemaker </li></ul><ul><li>Permanent Pacemaker Implantation if patient has symptoms of syncope/pre-syncope </li></ul>
  7. 8. <ul><li>Treatment and outcomes of left bundle-branch block patients with myocardial infarction who present without chest pain </li></ul><ul><li>Michael G. Shlipak, MD, MPH * , Alan S. Go, MD , Paul D. Frederick, MPH, MBA , Judith Malmgren, PhD , Hal V. Barron, MD, FACC || , John G. Canto, MD, MSPH, FACC¶ for the National Registry of Myocardial Infarction 2 Investigators </li></ul><ul><li>San Francisco VA Medical Center, San Francisco, California, USA </li></ul><ul><li>J Am Coll Cardiol, 2000; 36:706-712 © 2000 by the American College of Cardiology Foundation </li></ul>
  8. 9. Clinical Implications <ul><li>Common in old age, diabetics and female </li></ul><ul><li>In patient mortality higher for patients of MI with LBBB </li></ul><ul><li>Mortality is 50% higher for patients who do not present with chest pain but later diagnosed as MI (under recognised, late diagnosis, no reperfusion therapy, under treated) </li></ul>
  9. 10. SGARBOSSA CRITERIA <ul><ul><ul><li>Sgarbossa scores >= 3 have a low sensitivity and high specificity for predicting MI in bundle branch block </li></ul></ul></ul>1.) = or > 1 mm of concordant ST-elevation (in the same direction as the majority of the QRS complex) in at least one lead - (5 points) 2.) = or > 1 mm of ST-depression in lead V1, V2 or V3 – (3 points) 3.) = or > 5 mm of discordant ST-elevation – (2 points)

×