Electrocardiographic diagnosis of myocardial infarction in the presence of complete left bundle branch block

Mark E. Hands; E. Francis Cook; Peter H. Stone; James E. Muller; Tyler Hartwell; Burton E. Sobel; Robert Roberts; Eugene Braunwald; John D. Rutherford

doi:10.1016/0002-8703(88)90245-1

Electrocardiographic diagnosis of myocardial infarction in the presence of complete left bundle branch block

Mark E. Hands, E. Francis Cook, Peter H. Stone, James E. Muller, Tyler Hartwell, Burton E. Sobel, Robert Roberts, Eugene Braunwald, John D. Rutherford

Research output: Contribution to journal › Article › peer-review

72 Scopus citations

Abstract

Whether myocardial infarction (MI) can be diagnosed electrocardiographically in the presence of left bundle branch block (LBBB) is controversial. Our study sought to test the reliability of ECG criteria for diagnosing MI in patients with LBBB. Among 985 patients presenting within 18 hours of the onset of ischemic chest pain, 35 had complete LBBB. Acute MI was identified by serial MB-creatine kinase (CK) elevations and prior MI was determined by previously documented ECG and/or enzyme changes. Among those with LBBB, 24 patients had acute and/or prior MI, while 11 had neither. Eleven ECG criteria previously proposed for detecting MI in the presence of LBBB were evaluated. In patients presenting with ischemic chest pain and complete LBBB, presence of any one of the following ECG criteria was highly specific (90% to 100%) and predictive (85% to 100%) for acute or prior MI: Q waves in at least two of leads I, aV_L, V₅, or V₆; R wave regression from V₁ to V₄; notching of the upstroke of the S wave in at least two of leads V₃, V₄, or V₅, and primary ST-T wave changes in two or more adjacent leads.

Original language	English (US)
Pages (from-to)	23-31
Number of pages	9
Journal	American heart journal
Volume	116
Issue number	1 PART 1
DOIs	https://doi.org/10.1016/0002-8703(88)90245-1
State	Published - Jul 1988

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/0002-8703(88)90245-1

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@article{d0e8134e50e844988cb99a4a7f0d35db,

title = "Electrocardiographic diagnosis of myocardial infarction in the presence of complete left bundle branch block",

abstract = "Whether myocardial infarction (MI) can be diagnosed electrocardiographically in the presence of left bundle branch block (LBBB) is controversial. Our study sought to test the reliability of ECG criteria for diagnosing MI in patients with LBBB. Among 985 patients presenting within 18 hours of the onset of ischemic chest pain, 35 had complete LBBB. Acute MI was identified by serial MB-creatine kinase (CK) elevations and prior MI was determined by previously documented ECG and/or enzyme changes. Among those with LBBB, 24 patients had acute and/or prior MI, while 11 had neither. Eleven ECG criteria previously proposed for detecting MI in the presence of LBBB were evaluated. In patients presenting with ischemic chest pain and complete LBBB, presence of any one of the following ECG criteria was highly specific (90% to 100%) and predictive (85% to 100%) for acute or prior MI: Q waves in at least two of leads I, aVL, V5, or V6; R wave regression from V1 to V4; notching of the upstroke of the S wave in at least two of leads V3, V4, or V5, and primary ST-T wave changes in two or more adjacent leads.",

author = "Hands, {Mark E.} and Cook, {E. Francis} and Stone, {Peter H.} and Muller, {James E.} and Tyler Hartwell and Sobel, {Burton E.} and Robert Roberts and Eugene Braunwald and Rutherford, {John D.}",

note = "Funding Information: From the Cardiovascular Division, Department of Medicine, Brigham and Women{\textquoteright}s Hospital and Harvard Medical School; and Cooperating Institutions of the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Dr. Mark Hands supported by the Athelsan and Amy Saw Medical Research Fellowship, University of Western Australia, and in part by the Royal Australasian College of Physicians Travelling Scholarship. Received for publication Dec. 30, 1987; accepted Feb. 1, 1988. Reprint requests: Dr. John D. Rutherford, Cardiovascular Division, am and Women{\textquoteright}s Hospital, 75 Francis Boston, MA 02115.",

year = "1988",

month = jul,

doi = "10.1016/0002-8703(88)90245-1",

language = "English (US)",

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journal = "American heart journal",

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T1 - Electrocardiographic diagnosis of myocardial infarction in the presence of complete left bundle branch block

AU - Hands, Mark E.

AU - Cook, E. Francis

AU - Stone, Peter H.

AU - Muller, James E.

AU - Hartwell, Tyler

AU - Sobel, Burton E.

AU - Roberts, Robert

AU - Braunwald, Eugene

AU - Rutherford, John D.

N1 - Funding Information: From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; and Cooperating Institutions of the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Dr. Mark Hands supported by the Athelsan and Amy Saw Medical Research Fellowship, University of Western Australia, and in part by the Royal Australasian College of Physicians Travelling Scholarship. Received for publication Dec. 30, 1987; accepted Feb. 1, 1988. Reprint requests: Dr. John D. Rutherford, Cardiovascular Division, am and Women’s Hospital, 75 Francis Boston, MA 02115.

PY - 1988/7

Y1 - 1988/7

N2 - Whether myocardial infarction (MI) can be diagnosed electrocardiographically in the presence of left bundle branch block (LBBB) is controversial. Our study sought to test the reliability of ECG criteria for diagnosing MI in patients with LBBB. Among 985 patients presenting within 18 hours of the onset of ischemic chest pain, 35 had complete LBBB. Acute MI was identified by serial MB-creatine kinase (CK) elevations and prior MI was determined by previously documented ECG and/or enzyme changes. Among those with LBBB, 24 patients had acute and/or prior MI, while 11 had neither. Eleven ECG criteria previously proposed for detecting MI in the presence of LBBB were evaluated. In patients presenting with ischemic chest pain and complete LBBB, presence of any one of the following ECG criteria was highly specific (90% to 100%) and predictive (85% to 100%) for acute or prior MI: Q waves in at least two of leads I, aVL, V5, or V6; R wave regression from V1 to V4; notching of the upstroke of the S wave in at least two of leads V3, V4, or V5, and primary ST-T wave changes in two or more adjacent leads.

AB - Whether myocardial infarction (MI) can be diagnosed electrocardiographically in the presence of left bundle branch block (LBBB) is controversial. Our study sought to test the reliability of ECG criteria for diagnosing MI in patients with LBBB. Among 985 patients presenting within 18 hours of the onset of ischemic chest pain, 35 had complete LBBB. Acute MI was identified by serial MB-creatine kinase (CK) elevations and prior MI was determined by previously documented ECG and/or enzyme changes. Among those with LBBB, 24 patients had acute and/or prior MI, while 11 had neither. Eleven ECG criteria previously proposed for detecting MI in the presence of LBBB were evaluated. In patients presenting with ischemic chest pain and complete LBBB, presence of any one of the following ECG criteria was highly specific (90% to 100%) and predictive (85% to 100%) for acute or prior MI: Q waves in at least two of leads I, aVL, V5, or V6; R wave regression from V1 to V4; notching of the upstroke of the S wave in at least two of leads V3, V4, or V5, and primary ST-T wave changes in two or more adjacent leads.

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JF - American heart journal

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ER -

Electrocardiographic diagnosis of myocardial infarction in the presence of complete left bundle branch block

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