TOBY R. ENGEL, M.D., F.A.C.P.; RAJNIKANT SHAH, M.D.; LOUISE A. DePODESTA; WILLIAM S. FRANKL, M.D., F.A.C.P.; ROBERT L. KRAUSE, M.D., F.A.C.P.
Ischemia is traditionally considered a cause of intermittent left bundle-branch block (LBBB), and some patients have right precordial T-wave inversion in the normally conducted beats. Clinical correlates of T-wave abnormalities were examined in 46 consecutive patients with intermittent LBBB. Thirty-three patients (72%) had at least transient right precordial (V1-4) T-wave inversion suggesting ischemia in normally conducted beats. Seventeen such patients had no evidence of coronary heart disease, including five with normal arteriograms. During LBBB conduction, T-wave abnormalities (upright T-waves I, aVL, V5-6) were frequent (48%) and more common than among patients with permanent LBBB (p < 0.005). The T-wave abnormalities during LBBB conduction occurred in the absence of coronary heart disease in nine patients, including two with normal arteriograms. Thus, right precordial T-wave inversion may result from recent LBBB itself, associated with T-wave abnormalities during the LBBB, in the absence of coronary artery disease.
ENGEL TR, SHAH R, DePODESTA LA, FRANKL WS, KRAUSE RL. T-Wave Abnormalities of Intermittent Left Bundle-Branch Block. Ann Intern Med. 1978;89:204–206. doi: 10.7326/0003-4819-89-2-204
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Published: Ann Intern Med. 1978;89(2):204-206.
Cardiac Diagnosis and Imaging, Cardiology, Rhythm Disorders and Devices.
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