title: Significance of an isolated new right bundle branch block in a patient with chest pain.
abstract: Chest pain is a common presenting symptom in emergency departments, and a typical manifestation of acute myocardial infarction (AMI). Recognition of ECG changes in AMI is essential for timely diagnosis and treatment. Right bundle branch block (RBBB) may be an isolated sign of AMI, and was previously considered as a criterion for fibrinolytic therapy. Since the most recent European Society of Cardiology and American Heart Association guidelines in 2013, RBBB alone is no longer considered a diagnostic criterion of AMI, even if it occurs in the context of acute chest pain, as RBBB does not usually interfere with the interpretation of ST-segment alteration. Our case illustrates an acute septal myocardial infarction with an isolated RBBB, and thus the importance of recognising this pattern in order to permit timely diagnosis and treatment.
authors.affiliation: Internal Medicine Department, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Gilliot
authors.affiliation: Cardiology Department, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Monney
authors.affiliation: Cardiology Department, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Muller
authors.affiliation: Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology; D053840:Brugada Syndrome; D002036:Bundle of His / Q000473:pathology*; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000209:etiology; D000075224:Cardiac Conduction System Disease; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D004562:Electrocardiography; D006329:Heart Conduction System / Q000002:abnormalities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology