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Stuart P Swadron MD FRCPC FACEP FAAEMUniversity of Southern California

Improving Appropriateness of

Emergent Cath Lab Activation

1. Avoid False Positives

2. Avoid False Negatives

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CK-MB CK-MB Normal

200 ED Patients with Chest Pain and STE

• SYNDROME % PATIENTS

• LVH 25

• LBBB 15

• AMI 15

• Benign Early Repolarization 12

• RBBB 5

• Intraventricular Conduction Delay 5

• Aneurysm 3

• Pericarditis 2

• Undefined 18

Source: Brady WJ, Chari. Emergency Medicine Reports 19 (1998)

Plea for

sanity

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Plea for

sanity

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Plea for

sanity

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Give me 15 friggin’ minutes!

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LBBB and AMI

•CASE

• 47 year old male with chest pain x 2 hrs

• No previous cardiac history

LBBB and AMI

•CASE ONE

•VIDEOQuickTime™ and a

H.264 decompressorare needed to see this picture.

LBBB and AMI

•CASE ONE - EKG

LBBB and AMI

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LBBB and AMI LBBB and AMI

LBBB and AMI LBBB and AMI

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LBBB and AMI

BMJ 311 : 1660 (23 December 1995)

LBBB and AMI

Am Heart J 2011;161:698-704.

401 patients with CP and LBBB (New 64%)

116 patients (29%) had MI

MI

RATES

86% with concordant ECG changes

27% without concordant ECG changes

LBBB and AMI

•INAPPROPRIATE DISCORDANCE

LBBB and AMI

•EXCESSIVE CONCORDANCE

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Thank

you!

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swadron@usc.ed

u

mailto:swadron@usc.edumailto:swadron@usc.edu