11 ste-mimics part2

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  • Chang AM, Shofer FS, Tabas JA, et al. Lack of association between left bundle-branch block and acute myocardial infarction in symptomatic ED patients . Am J Emerg Med 2009;27:916-921.
  • Lets examine these findings closer
  • Lets examine these findings closer
  • The take home message is that T-Wave discordance can cause both ST-Depression and ST-Elevation. The trick is knowing that the amount of ST-elevation or depression is directly proportionate to the depth or height of the preceding wave.
  • 11 ste-mimics part2

    1. 1. 12-LeadElectrocardiography a comprehensive course -Mi mics STE P art 2 Adam Thompson, EMT-P, A.S.
    2. 2. Left Bundle Branch Block• LBBB may also mimic a STEMI – Delayed conduction due to a block of both the Left Anterior Fascicle & Left Posterior Fascicle. – Atrial rhythm with QRS duration > 120 ms and negatively deflected QRS complex in V1. – May cause ST-elevation due to T-Wave discordance.
    3. 3. LBBB Research• The evidence shows that there is no correlation between a new LBBB and ACS despite what was previously believed. – Am J Emerg Med 2009;27:916-921.
    4. 4. STE due to LBBB• Like LVH, STE may be caused by the T wave discordance normally found with a LBBB.• Acute Myocardial Infarction can still be diagnosed in the presence of LBBB. – This is not a commonly known fact, and many texts teach that an AMI can not be identified in the presence of LBBB
    5. 5. LBBB
    6. 6. LBBB
    7. 7. LBBB
    8. 8. LBBB
    9. 9. LBBB
    10. 10. T-Wave Discordance
    11. 11. The End• More in the next lesson

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