What is appropriate discordance?
Appropriate discordance describes a pattern of repolarization abnormality (seen with left bundle branch block, paced rhythms, VT, PVCs, etc.) in which the ST segment and T wave are directed opposite to the main vector of the QRS complex: ST depression and T wave inversion in leads with a dominant R wave.
How can you tell the difference between old and new LBBB?
Twenty-four-hour duration was selected as a cutoff between new and old LBBB. LBBB was classified as “new” if a tracing satisfied one of the following conditions: 1. A prior ECG with normal QRS duration ( Ͻ 110 ms) 12 within 24 hours before the LBBB tracing without T- wave abnormalities.
What is discordant ST elevation?
ST-elevation is “excessively discordant” when the ST-elevation (measured at the J-point) is > 0.25 or 25% the depth of the S-wave. ST-depression is “excessively discordant” when the ST-depression (measured at the J-point) is > 0.3 or 30% the height of the R-wave.
What is concordance and discordance in ECG?
The original three criteria used to diagnose infarction in patients with LBBB are: Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5) Concordant ST depression > 1 mm in V1-V3 (score 3) Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex (score 2)
How can you tell if you have a left bundle branch block?
How is left bundle branch block diagnosed?
- Echocardiogram to check blood flow in the heart and heart motion.
- Cardiac stress testing to look for coronary artery disease or other abnormalities.
- Blood work to assess cholesterol levels and other factors.
Can you see ST elevation with LBBB?
Because in LBBB, in leads V1-V3, the QRS is always predominantly negative (deep S-wave), the normal state of a patient with LBBB is ST Elevation in these right precordial leads.
How do you read LBBB on an ECG?
A simple way to diagnose a left bundle branch in an ECG with a widened QRS complex (> 120 ms) would be to look at lead V1. If the QRS complex is widened and downwardly deflected in lead V1, a left bundle branch block is present.
Can you live a normal life with left bundle branch block?
In young and healthy people, left bundle branch block is rare. This condition seems to have little effect on how long you live if you have no other underlying heart problems. You may not need any treatment at all, especially when you have no other disease affecting your heart.
Can LBBB have ST elevation?
The presence of a left bundle branch block (LBBB) on EKG can make recognition of an acute ST segment elevation myocardial infarction (STEMI) difficult.
What does concordance mean in cardiology?
Concordance refers to chambers and valves that are properly aligned, or a normally aligned heart.
How does LBBB diagnose MI?
identified three ECG criteria that may improve the diagnosis of MI in patients with LBBB: ST-elevation of ≥1 mm and concordant with the QRS complex (5 points) ST-segment depression ≥1 mm in lead V1, V2, or V3 (3 points) ST elevation ≥5 mm and discordant with the QRS complex (2 points)
Should I worry about left bundle branch block?
A left bundle branch block can signify a serious underlying heart condition, but not always. In people under 50 without other comorbidities, LBBB is typically benign. However, further testing is warranted if you have LBBB and other risk factors for cardiovascular disease.
What is the best treatment for LBBB?
First-line treatment of painful LBBB is usually sinus node suppression using beta-blockers or ivabradine. Alternative therapies include cardiac resynchronization therapy or His-bundle pacing. However, in some cases, right ventricular pacing alone may be sufficient to control patient symptoms.
Can you diagnose a STEMI with a LBBB?
Can you diagnose STEMI here? —Yes! The diagnosis of STEMI in the presence of left bundle branch block has been problematic for years. Until recently, the guidelines for management of Acute MI recommended cath lab activation for patients with chest pain and new LBBB.
Is LBBB still a STEMI equivalent?
In the recent version of the guidelines, LBBB is no longer an automatic STEMI equivalent.
When is left bundle branch block serious?
Left bundle branch block results when something disrupts the electrical impulse that controls your heartbeat. It’s often not serious if you have no underlying conditions. People with heart conditions may need a pacemaker or cardiac resynchronization therapy to manage this condition.
What is life expectancy with LBBB?
The mortality rates were 4.5%/year for patients with LBBB, 2.5%/year for patients with RBBB, and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95% CI: 0.4-2.2; P = 0.8).
Can we give beta blockers in LBBB?
Patients with DCM and acceleration-dependent LBBB may benefit from restoration of a narrow QRS complex by suppressing the heart rate with beta-blocker.
What is positive concordance in ECG?
The presence of concordance suggests that the tachycardia has a ventricular origin. Positive concordance probably indicates that the origin of the tachycardia lies on the posterior ventricular wall; the wave of depolarisation moves towards all the chest leads and produces positive complexes.
What does negative concordance mean?
ventricular tachycardia
When there is a negative concordance, it almost always represents a life-threatening condition called ventricular tachycardia because there is no other condition that suggests any abnormal conduction from the apex of the heart to the upper parts.
Is LBBB a serious heart condition?
Is LBBB always serious?
Is new LBBB criteria for STEMI?
Whereas in the past, the presence of new or presumably new LBBB in a patient with symptoms compatible with AMI was considered a class I indication for emergent reperfusion therapy (STEMI‐equivalent, also known as occlusion MI, or OMI), the 2013 American College of Cardiology Foundation/American Heart Association …
Is beta blocker contraindicated in bundle branch block?
Professor Dollery: A beta receptor blocking drug should not be used in anybody who has complete block and only very cautiously in the presence of bundle branch block. Minor conduction defects do not appear to be contraindications to beta blockade.
What is left axis deviation on ECG?
In electrocardiography, left axis deviation (LAD) is a condition wherein the mean electrical axis of ventricular contraction of the heart lies in a frontal plane direction between −30° and −90°. This is reflected by a QRS complex positive in lead I and negative in leads aVF and II.