title: Left bundle branch block, chest pain and catheterization laboratory activation: an unavoidable cascade reaction?
abstract: Identification of acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) remains challenging. European guidelines recommend prompt reperfusion therapy in patients with suspected ongoing myocardial ischemia and new or presumably new LBBB, whereas AHA/ACC guidelines state that LBBB should not be considered diagnostic of AMI in isolation. Sgarbossa criteria and their recent modified version with the introduction of ST/S ratio can be helpful in this setting. A clinical-instrumental algorithm to manage suspected AMI in the presence of LBBB has been recently proposed. We present five paradigmatic clinical cases.
authors.affiliation: Division of Cardiology, School of Medicine, University of Perugia, Perugia, Italy. Electronic address: ciliberti.giuseppe@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Ciliberti
authors.affiliation: Division of Cardiology, S. Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Del Pinto
authors.affiliation: Division of Cardiology, School of Medicine, University of Perugia, Perugia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Notaristefano
authors.affiliation: Division of Cardiology, S. Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Zingarini
authors.affiliation: Division of Cardiology, School of Medicine, University of Perugia, Perugia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ambrosio
authors.affiliation: Division of Cardiology, S. Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cavallini
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000150:complications* / Q000175:diagnosis*; D002309:Cardiology / Q000592:standards; D002637:Chest Pain / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000592:standards*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis*; D017410:Practice Guidelines as Topic
keywords: Acute coronary syndromes; Acute myocardial infarction; Cath lab; Left bundle branch block