Medicine Guy
Forum Junior
Topics: 11
Posts: 68
|
How will you diagnose acute myocardial infarction
in the setting of Left bundle Branch Block.
___________________
www.xpindia.com - affordable medical web hosting
|
| zaki
Forum Guru
Topics: 92
Posts: 398
|
quite difficult to dx, i don't remeber exactly but
1.if its of acute onset LBBB then its by itself indicate acute MI
2. if the pt has previous lbbb (evidence by previous ecg in ward or in pts records) then compare it with the recent one taken during the the pain, and if it show elevation and inversion not present on previous then it indicate ischemia or infarction.
3.do ECHO in the emergency or in the ward and look of any akinetic area supplemnt with the cardiac enzymes(CK-MB, Troponin-I/troponin T)
4. simply on cardiac enzymes
please do explain it DR.Rober james , and i must say its a good qs to ask,but i don't think Qs like this come in step 2
___________________
Maverick
|
| Medicine Guy
Forum Junior
Topics: 11
Posts: 68
|
Ok zaki, here it is, sorry i could not be online...
***************************************
compare with previous ecg
1- Concordant T waves
2- Q in V5 n V6
3- Deep S in V5 n V6
4- in a long strip of ECG tracing, if U get to see an ectopic wave with
a q wave
5- Q > or = 0.04 sec in lead 1
6- Rapid series of St- T changes
7- Acute ST elevation, disproportionate to QRS duration.
8- Q of any size in V6
9- Q in II,III,aVF
10-Loss of R in precordial leads or R wave regression.
11- Notching on upstroke of S wave in atleast 2 leads ( V3,V4,V5)
___________________
www.xpindia.com - affordable medical web hosting
|
| zaki
Forum Guru
Topics: 92
Posts: 398
|
THANK YOU Dr Robert James 
___________________
Maverick
|
| zaki
Forum Guru
Topics: 92
Posts: 398
|
well i come across one article publish in 1996 which recommend 3 things to dx acut mi in the presence of prior lbbb which are
ST segment elevation in any lead >1 mm which is concordant with qrs complex (5 points)
st segment depression of 1mm or more in V1, V2, OR V3 (3 points)
ST segment elevation disconcordant to qs complex of more than 5 mm (2 points).
when all these are present the there is 95 % specificity
and they only include those pt who have acute mi at that point in time. with symptoms
and they also say that all other criterias are not as sensitive or specific then these 3 criterias are for correctly dx acute mi and give thrombolytic therapy.
i also find that criteria easy to remeber
___________________
Maverick
|
|
| |
| | | | | |
