Poor Outcome of Right Bundle Branch Block Coexist with ST-Elevation Myocardial Infarction

Arifta Devi Anggraeni, Andrianto Andrianto, Ivana Purnama Dewi, Eka Prasetya Budi Mulia, Anudya Kartika Ratri

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1 Citation (Scopus)

Abstract

Background: The incidence of new-onset right bundle branch block (RBBB) coexistence with ST-elevation myocardial infarction (STEMI) has been associated with higher in-hospital mortality than those without RBBB. Case: We present three cases of new-onset RBBB that coexist with STEMI. Case I: a 64 years old male presented Killip I STEMI inferior-anterior with RBBB as new-onset. Rescue percutaneous coronary intervention (PCI) after failed thrombolytic was performed. New-onset atrial fibrillation (AF) with rapid ventricular response worsened his hemodynamic profile, leading to cardiogenic shock. Case II: an 80 years old male presented Killip IV late-onset anterior STEMI with new-onset RBBB. Cardiogenic shock got worsened after PCI. Case III: a 65 years old male presented Killip II extensive anterior STEMI with new-onset RBBB who underwent a primary PCI. After PCI, there was recurrent ventricular tachycardia (VT), worsening cardiogenic shock, and transient AV block. Discussion: The right bundle branch blood supply is mainly provided by a septal branch of the left descending artery (LAD). Therefore, it may indicate proximal LAD occlusion and extensive infarction. Thus, catastrophic events may occur, including acute heart failure, AV block, malignant ventricular arrhythmia, new-onset AF, and mostly cardiogenic shock, despite initiating reperfusion being performed without delay once the diagnosis is confirmed. Conclusion: New RBBB suggests a poor short-term prognosis due to its complication. Higher mortality is mostly linked to worsening cardiogenic shock.

Original languageEnglish
Pages (from-to)43-47
Number of pages5
JournalHeart Science Journal
Volume3
Issue number1
DOIs
Publication statusPublished - Jan 2022

Keywords

  • Prognosis
  • Right Bundle Branch bBock
  • ST-Elevation Myocardial Infarction

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