A case report: New-Onset Right Bundle Branch Block in Evolving Anterior STEMI: A Marker for Critical Proximal LAD Occlusion

Abstract

ST-elevation myocardial infarction is part of acute coronary syndrome, indicating the occurrence of total coronary artery occlusion. This condition requires immediate revascularization to restore blood flow and myocardial reperfusion as quickly as possible, which can be accomplished mechanically through Primary Percutaneous Coronary Intervention or pharmacologically with fibrinolytic drugs. A myocardial infarction with ST elevation and new right bundle branch block (RBBB) is one of the other ECG abnormalities linked to higher morbidity and mortality. Reported: A male patient 48 years old, presented to the emergency room with complaints of chest pain typical of angina onset in the last 30 minutes. ECG on arrival at the hospital showed new ST elevation of 2 mm in leads V1-V2. An hour later, new RBBB with a significant ST segment elevation in leads V1–V3 was seen on serial ECG. The patient underwent another serial ECG an hour after initial serial ECG to observe the evolution and ST elevation was seen rising in V1-V3 and the previous RBBB disappeared. Physical examination reveal of the impression within normal limits, with troponin I > 109 U / L. The patient was referred to Dr. M. Djamil General Hospital for Primary PCI. One stent was implanted after the angiography results revealed a 100% lesion in the proximal LAD and significant stenosis in the proximal OM1. Thus, the hypothesis that new-onset RBBB should raise the suspicion of critical proximal LAD coronary blockage in a STEMI patient with ischemic symptoms is supported by this case report.