Untitled - Romanian Journal of Cardiology

Revista Română de Cardiologie, Vol. XXIII
Suplimentul A, 2008
Myocardial infarction with Q
wave and right bundle branch
block
Radu Grigore 1 , Cristina Șuțescu 2 ,
Ileana Grigore 3
1
County Hospital „Sf. Apostol Andrei” Galati
2
Center of diagnosis and treatment „N. kretzulescu”
Bucuresti
3
Center of diagnosis and treatment Galati
Classic, because RBBB alters only terminal position of
QRS and also the Q wave in MI alters only the initial
portion of QRS, it accepts that RBBB does not interfere
with the diagnosis with Q wave. On the normal heart
the initial portion of QRS is generated by the left ventricle,
the contribution of right ventricle being insi g-
nificant. However when the left ventricle looses myocardial
tissue in MI and in other pathological states,
which changes the ratio of electrical forces between
the two ventricle, the weight of right ventricular in the
depolarization of initial portion of QRS is not to be
ignored. There were described false negative Q waves
especially in the inferior MI and false positive Q waves
in MI anteroseptal (“RBBB dependent Q wave”). There
was described the diminution of the necrosis Q wave
after aortocoronarian bypass in the inferior MI. The
vectorial influences between RBBB and Q waves can
mask or simulate an acute MI. There were described
Q waves in right precordial in acute MI and these Q
waves have appeared on the ventricular complexes with
intermittent RBBB.
Personal observations: 1. F. 78 years old with AVB
Wenckebach without the necrosis Q waves; after four
months slow atrial fibrillation 40/min with intermittent
RBBB. The complexes with RBBB are with anteroseptal
necrosis which disappear on the complexes without
RBBB. This is a case with “RBBB dependent Q wave”.
2. M. 70 years old with old anteroseptal MI and RBBB
(QRV1 and QSV2). After 10 days the patient is with
acute pulmonary edema and with RBBB with other
morphology, rR’V1 and Rr’V2 without necrosis Q waves.
It is possible that the necrosis Q waves are canceled by R
wave of a posterior acute MI. 3. M. 72 years old with old
anterior and inferior MI and bypass aortocoronarian.
There is a slow atrial fibrillation and intermittent RBBB.
In the precordials after a ventricular extrasystole; RBBB
appear which diminishes the necrosis Q waves of QS
(0.08 sec) in V1-V4 to 0.03-0.04 sec. 4. M. 71 years
POSTER I
old with old anterior MI. After one year the anterior
QS waves (0.08 sec) disappear and it inscribes RBBB
with qR V1-V3 (0.04-0.03 sec). It is possible that RBBB
contributes to the diminishing of the necrosis Q waves.
5. F. 81 years old with old MI anteroseptal. On the same
ECG the appearance of RBBB have diminished the
width of necrosis Q wave from 0.08 sec in V1 to 0.04
sec and the disappearance of the necrosis Q wave in V2.
6. F. 63 years old with old MI posterior and acute MI
anteroseptal masked by LBBB. The intermittent RBBB
unmasks anteroseptal MI.
Conclusions: The interferences between RBBB and
the necrosis Q wave put various problems of electrocardiography
diagnosis.
35. Evaluarea percepţiei
modificării stilului de viaţă la
pacientul cu boala coronariana
aterosclerotica - studiu pe 500
de cazuri
Horaţiu Rus, Codruţ Ciurea
Facultatea de Medicină. Universitatea Transilvania
Braşov
Introducere: Recomandarile privind modificarea stilului
de viata sunt esentiale in managementul modern al
pacientului cu boala coronariana ischemica (BCI).
Obiectiv: Evaluarea gradului de educatie la pacientii
cu BCI in relatie cu recomandarile privind modificarea
stilului de viata.
Material si metoda: Am evaluat 500 de pacienti cu
BCI privind gradul lor de instructie in ceea ce priveste
recomandarile privind modificarea stilului de viata.
Am considerat ca si variabile: varsta, sexul, greutatea,
prezenta diabetului si a tratamentului medicamentos.
Statistica Pearson.
Rezultate: Majoritatea p. cu BCI. (90%), relateaza prezenta
unui grad de instructie medicala in ceea ce priveste
modificarea stilului de viata. Recomandarea de
modificare a regimului alimentar a fost raportata cel
mai frevent (80%), urmata de reducerea aportului de
sare (52%), reducerea consumului de alcool (35%) si
incu ra jarea antenamentului fizic.(30%). Recomandarile
privind modificarea stilului de viata au fost raportate