Key result
A 67-year-old woman with inferior STEMI and newly diagnosed RBBB rapidly developed hemodynamic instability and sustained ventricular tachycardia, leading to death.
Why the study?
Newly diagnosed RBBB is being investigated as a potential electrocardiographic diagnostic for life-threatening STEMI equivalents, as it represents a poor prognostic sign associated with higher mortality.
Case Report (n=1)
This case highlights that newly diagnosed RBBB in the setting of STEMI is a poor prognostic sign associated with rapid clinical deterioration and mortality.
New RBBB in inferior STEMI signals high mortality risk; hypothesis-generating and requires prospective validation.
A newly diagnosed Right Bundle Branch Block is being investigated as a potential electrographic diagnostic for life-threatening STEMI equivalents (RBBB). RBBB was identified in 7.3 percent of individuals with NSTEMI and 9.1 percent of patients with STEMI. Previously, urgent angiography was suggested for patients with STEMI and Left Bundle Branch Block (LBBB), but it is now recommended for patients with STEMI and Right Bundle Branch Block (RBBB), as RBBB is a poor prognostic sign associated with higher mortality in patients with STEMI. We report on a 67-year-old woman who had been experiencing persistent heartburn for ten hours before to admittance to the hospital. Complaints of cold sweating and had comorbidities of diabetes mellitus, hypertension, and ischemic stroke 2 months ago. On arrival, a 12-lead electrocardiogram (ECG) revealed STEMI inferior with RBBB. The cardiac enzyme marker was increased due to an elevated serum troponin-I level of 10 ng/mL (cut off 0,01), an elevated serum creatinine level of 3.7 mg/dL, leukocytosis (13850/L), and compensatory metabolic acidosis. She was treated with aspirin, clopidogrel, statins, ACE-i, and anticoagulants after being diagnosed with inferior STEMI with RBBB. As a practical matter of the COVID19 screening process, the patient did not require primary coronary intervention. The patient developed hemodynamic instability within two hours of being brought to the CVCU. The patient originally presented with transient ventricular tachycardia, which progressed to sustained ventricular tachycardia. Defibrillation with a dosage of 360 joules was used in conjunction with high-quality cardiopulmonary resuscitation until the patient was declared dead.
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Ramadhan et al. (2022) conducted a case report in ST Segment Elevation Myocardial Infarction (STEMI) with Right Bundle Branch Block (RBBB) (n=1). Right Bundle Branch Block (RBBB) was evaluated. A 67-year-old woman with inferior STEMI and newly diagnosed RBBB rapidly developed hemodynamic instability and sustained ventricular tachycardia, leading to death.
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