The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardi...The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardial infarction (AMI), delaying the diagnostic-therapeutic iter, with an important impact on prognosis. We describe the case of a woman of 59 years with LBBB, came to our observation for a constrictive chest pain associated with dyspnea. The diagnostic workup for suspected acute coronary syndrome (ACS), initially conducted only on the analysis of the electrocardiogram (negative TnI at entry), showed the presence of coronary arteries free of stenosis. However, the diagnostic confirmation of AMI was completed after the rise of cardiac markers and the electrocardiographic changes. This case confirm the difficulty about the diagnosis of AMI in patients with LBBB and stresses, however, as the use of some criteria proposed in the literature [1-3] can guide to its identification, directing patient to an appropriate treatment.展开更多
目的:探讨左束支走行畸形与左束支阻滞的关系。方法:尸检心脏标本10例,8例患完全性左束支阻滞,2例患左前分支阻滞。采用 Lev 氏改良法,对心脏传导系统进行连续切片,每张厚度为5μm,每20张染色一张,染色方法为 HE、EVG、Masson。光镜下...目的:探讨左束支走行畸形与左束支阻滞的关系。方法:尸检心脏标本10例,8例患完全性左束支阻滞,2例患左前分支阻滞。采用 Lev 氏改良法,对心脏传导系统进行连续切片,每张厚度为5μm,每20张染色一张,染色方法为 HE、EVG、Masson。光镜下对切片进行观察。结果:在10例心脏标本中,发现4例左束支走行异常,表现在左束支或其分支走行于室间隔心肌隧道内。其病理改变包括束支纤维化、脂肪浸润、细咆浸润、空泡或嗜伊红变性、中度弹性组织变性等。结论:本组有4例心脏病理检查结果显示左束支走行畸形,该现象可能与左束支阻滞有关。展开更多
目的探究真性左束支传导阻滞(true left bundle branch block,t-LBBB)心电图特征与慢性稳定型心力衰竭治疗效果的相关性.方法选取该院2019年3月—2020年1月收治的92例慢性稳定型心力衰竭患者为研究对象,依据其心电图检查结果,分为对照组...目的探究真性左束支传导阻滞(true left bundle branch block,t-LBBB)心电图特征与慢性稳定型心力衰竭治疗效果的相关性.方法选取该院2019年3月—2020年1月收治的92例慢性稳定型心力衰竭患者为研究对象,依据其心电图检查结果,分为对照组[35例,非t-LBBB(nt-LBBB)]、观察组(57例,t-LBBB),两组均接受心脏再同步化治疗,治疗后持续随访1年.比较两组患者治疗前及末次随访时的心功能指标[美国纽约心脏病学会(New York Heart Association,NYHA)心功能分级、左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室射血分数(left ventricular ejection fraction,LVEF)、QRS波宽]、末次随访术后应答情况,分析t-LBBB心电图特征与慢性稳定型心力衰竭手术应答之间相关性.结果两组患者治疗前的NYHA、LVEDd、LVEF、QRS波宽水平比较,差异无统计学意义(P>0.05);末次随访时,观察组的NYHA、LVEDd、QRS波宽水平均低于对照组,LVEF水平高于对照组,组间差异有统计学意义(P<0.05).观察组手术应答率为94.74%,高于对照组的74.29%,差异有统计学意义(P<0.05).经Spearman相关性分析,t-LBBB与患者心脏再同步化治疗呈正相关(r=0.758,P<0.05).结论存在t-LBBB心电图特征的慢性稳定性心力衰竭患者,心脏再同步化治疗的结局更为理想.展开更多
文摘The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardial infarction (AMI), delaying the diagnostic-therapeutic iter, with an important impact on prognosis. We describe the case of a woman of 59 years with LBBB, came to our observation for a constrictive chest pain associated with dyspnea. The diagnostic workup for suspected acute coronary syndrome (ACS), initially conducted only on the analysis of the electrocardiogram (negative TnI at entry), showed the presence of coronary arteries free of stenosis. However, the diagnostic confirmation of AMI was completed after the rise of cardiac markers and the electrocardiographic changes. This case confirm the difficulty about the diagnosis of AMI in patients with LBBB and stresses, however, as the use of some criteria proposed in the literature [1-3] can guide to its identification, directing patient to an appropriate treatment.
文摘目的:探讨左束支走行畸形与左束支阻滞的关系。方法:尸检心脏标本10例,8例患完全性左束支阻滞,2例患左前分支阻滞。采用 Lev 氏改良法,对心脏传导系统进行连续切片,每张厚度为5μm,每20张染色一张,染色方法为 HE、EVG、Masson。光镜下对切片进行观察。结果:在10例心脏标本中,发现4例左束支走行异常,表现在左束支或其分支走行于室间隔心肌隧道内。其病理改变包括束支纤维化、脂肪浸润、细咆浸润、空泡或嗜伊红变性、中度弹性组织变性等。结论:本组有4例心脏病理检查结果显示左束支走行畸形,该现象可能与左束支阻滞有关。
文摘目的探究真性左束支传导阻滞(true left bundle branch block,t-LBBB)心电图特征与慢性稳定型心力衰竭治疗效果的相关性.方法选取该院2019年3月—2020年1月收治的92例慢性稳定型心力衰竭患者为研究对象,依据其心电图检查结果,分为对照组[35例,非t-LBBB(nt-LBBB)]、观察组(57例,t-LBBB),两组均接受心脏再同步化治疗,治疗后持续随访1年.比较两组患者治疗前及末次随访时的心功能指标[美国纽约心脏病学会(New York Heart Association,NYHA)心功能分级、左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室射血分数(left ventricular ejection fraction,LVEF)、QRS波宽]、末次随访术后应答情况,分析t-LBBB心电图特征与慢性稳定型心力衰竭手术应答之间相关性.结果两组患者治疗前的NYHA、LVEDd、LVEF、QRS波宽水平比较,差异无统计学意义(P>0.05);末次随访时,观察组的NYHA、LVEDd、QRS波宽水平均低于对照组,LVEF水平高于对照组,组间差异有统计学意义(P<0.05).观察组手术应答率为94.74%,高于对照组的74.29%,差异有统计学意义(P<0.05).经Spearman相关性分析,t-LBBB与患者心脏再同步化治疗呈正相关(r=0.758,P<0.05).结论存在t-LBBB心电图特征的慢性稳定性心力衰竭患者,心脏再同步化治疗的结局更为理想.
