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在所有因 ACS 就診的病人中
心電圖呈現 LBBB 者約佔 2%
因 LBBB 而啟動的緊急心導管患者
其實 False activation 比例高達 44%
許多人並未真的有嚴重阻塞的冠狀動脈
若因心肌梗塞產生 LBBB
通常梗塞的範圍是在前壁或前縱隔壁
且是大範圍的受損
最新觀念：心電圖為 LBBB 時的 ACS 流程圖
以往都要確定是否為 New-onset LBBB
新版流程不必去界定新舊, 而是 看型態
現在已經不算幾分, 就單純用上面的 algorithm
The criteria of Sgarbossa
can be used in case of a LBBB and suspicion of infarction are :
1. ST elevation > 1mm in leads with a positive QRS complex
(concordance in ST deviation) (score 5)
任意導程出現同向 Concordant ST elevation ≥1mm ( 最重要)
2. ST depression > 1 mm in V1-V3
Concordance in ST deviation (score 3)
V1, V2 或 V3 出現 ST depression ≥1mm
3. ST elevation > 5 mm in leads with a negative QRS complex
inappropriate discordance in ST deviation (score 2)
任意導程出現反向 discordant ST elevation ≥5mm
This criterion is sensitive, but not specific (?) for ischemia in LBBB.
It is however associated with a worse prognosis, when present in LBBB during ischemia.
若把以上三個條件合併一起檢視, 敏感度為78％而 特異度為90% (?)
研究發現出現concordant ST elevation 時
有較高的準確性
RBBB has up to 1mm of normal STD in V1-V3,
but ONLY when there is an R'-wave !!
That ST depression is rarely > 1 mm
(and then only when the R'-wave is very large, such as in RVH )
如果 V1 有 RSR' 後面跟著 STD 合理
V2, 3 若沒有 RSR' 後面有 STD 要懷疑 Post infarction
不能都用 RBBB 解釋
http://www.emnote.org/emnotes/sgarbossa-criteria
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