Clinical symptoms and myocardial infarction in left bundle branch block patients

In patients with left bundle branch block (LBBB) and acute chest pain, the association between the clinical presentation and the diagnosis of myocardi al infarction has not been investigated. We sought to identify features in the clinical history of patients with LBBB and acute cardiopulmonary sympto ms that predict myocardial infarction among candidates for reperfusion ther apy. We retrospectively studied a consecutive cohort of 75 patients (94 pre sentations) who presented to a university emergency department from 1994 to 1997 with LBBB on initial electrocardiogram (ECG) and acute chest pain of greater than or equal to 20 min duration or acute pulmonary edema. Among th e 94 presentations meeting criteria for the cohort, 26 (28%) had confirmed myocardial infarction. Coronary heart disease risk factors, past cardiac hi story, prior LBBB on the EGG, and presenting symptoms did not predict wheth er patients were having myocardial infarction. The clinical history was not effective at distinguishing LBBB patients with myocardial infarction among patients who appeared to be candidates for acute reperfusion therapy. Copy right (C) 2000 S. Karger AG, Basel.