Yochai Birnbaum

Baylor College of Medicine, USA

Title: Diagnosing STEMI in patients with RBBB

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Biography

Yochai Birnbaum has completed his MD in 1982 at the Hebrew University, Jerusalem, Israel. He is a Professor of Medicine at Baylor College of Medicine, Houston, Texas. He has published 384 papers in reputed journals and has been serving as an editorial board member of several journals. He is the Editor in Chief of Cardiovascular Drugs and Therapy

Abstract

The 2017 ESC guidelines for STEMI also specify “Patients with myocardial infarction and RBBB have a poor prognosis. It may be difficult to detect transmural ischemia in patients with chest pain and RBBB. Therefore, a primary percutaneous coronary intervention strategy (emergent coronary angiography and percutaneous coronary intervention if indicated) should be considered when persistent ischemic symptoms occur in the presence of RBBB”. However, recent studies have questioned this recommendation. There are no data on outcomes with and without primary percutaneous coronary intervention in patients with chest pain and presumed new RBBB without ST deviation. Diagnosing ST elevation in the inferior and lateral leads can easily be done in patients with RBBB. However, most patients with RBBB have ST depression in the anterior leads on their baseline ECG. Therefore, diagnosing inferolateral (true posterior) STEMI equivalent in patients with RBBB and baseline ST depression in V1–V3 is difficult. It is also unclear whether the threshold for ST elevation in the anterior leads V1–V3 should be reduced. It could be that the adverse outcomes seen in patients with RBBB is related to underdiagnosis of inferolateral and anterior STEMI.