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Extreme Right Axis Deviation in Acute Myocardial Infarction: A Hazardous Signal of Poor Prognosis

Authors :
Shuo Pan
Dan Yang
Junkui Wang
Fuqiang Liu
Qingyu Wang
Source :
The American Journal of Case Reports
Publication Year :
2018
Publisher :
International Scientific Information, Inc., 2018.

Abstract

Patient: Male, 72 Final Diagnosis: Acute myocardial infarction Symptoms: — Medication: Cardiac catheterization Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: New-onset extreme right axis deviation and right bundle branch block (RBBB) are rare during acute myocardial infarction (AMI), and has only been reported in several cases reflecting the severity of AMI. It could predict severe clinical complications and higher risks in coronary artery disease. Although there is little electrophysiological explanation, the complications are severe. They should be emphasized in newly diagnosed extreme right axis deviation and RBBB in AMI. Case Report: A 72-year-old male was admitted to our department with a chief complaint of intermittent retrosternal chest pain and was diagnosed with extensive anterior myocardial infarction with RBBB, by elevated myocardial enzymes and ECG. The main wave direction of QRS in lead aVR was positive and showed an extreme right axis deviation. After a month, the patient’s chest distress and the RBBB vanished, but a right axis deviation still existed. The echocardiogram showed prior extensive anterior myocardial infarction (including apex myocardia) and lower LVEF. Conclusions: New diagnosed RBBB and right axis deviation is uncommon and could be a useful clue to evaluate myocardial ischemia in AMI cases. This electrocardiographic marker can identify coronary artery occlusion where ST-segments are hard to evaluate, and hence, patients may benefit most from early and complete revascularization strategies such as primary angioplasty.

Details

ISSN :
19415923
Volume :
19
Database :
OpenAIRE
Journal :
American Journal of Case Reports
Accession number :
edsair.doi.dedup.....7500bc80430762b3be022b47c471718f