title: ECG patterns confounding the ECG diagnosis of acute coronary syndrome: left bundle branch block, right ventricular paced rhythms, and left ventricular hypertrophy.
abstract: The ECG has limitations in the evaluation of the chest-pain patient, including the presence of confounding ECG patterns; the ECG patterns that confound the diagnosis of acute myocardial infarction(AMI) include left bundle branch block (LBBB), ventricular paced rhythms (VPR), and left ventricular hypertrophy (LVH). These patterns produce new ST-segment/T-wave abnormalities, which are the new normal findings in these patients and may lead the clinician astray in two distinct instances: (1) diagnosing ECG change related to acute coronary syndromes (ACS) when the abnormality results solely from the confounding pattern; and (2) not acknowledging the confounding nature of these ECG patterns in the evaluation of potential ACS, thereby placing excessive diagnostic confidence in the ECG. This article highlights the diagnostic dilemma encountered in these confounding ECG patterns; the discussion focuses on the expected ECG abnormalities in these patients and the findings seen in ACS.
authors.affiliation: Department of Emergency Medicine and Internal Medicine, University of Virginia, Charlottesville, 22908, USA. wb4z@virginia.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Brady
authors.forename: Brian
authors.initials: B
authors.lastname: Lentz
authors.forename: Kevin
authors.initials: K
authors.lastname: Barlotta
authors.forename: Richard A
authors.initials: RA
authors.lastname: Harrigan
authors.forename: Theodore
authors.initials: T
authors.lastname: Chan
mesh_terms: D002037:Bundle-Branch Block / Q000209:etiology / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology*; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D013577:Syndrome; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology*