Title : Yasser’s criterion of inferior ST-segment discrepancy deviations in AF with aberrancy and Sgarbosa criteria - a new cardiovascular discovery and management - a case report
Abstract:
Rationale: Diagnosis of ST-segment elevation myocardial infarction in the presence of left bundle branch block (LBBB) is challenging and infarction equivalent. Therefore, the intravenous infusion of a thrombolytic may be a crucial step. Emergent Sgarbosa criteria and their modification are guided by advantageous guide keys. Atrial fibrillation represents the risk of arrhythmia in the presence of a left bundle branch block. Interestingly, the presentation of myocardial infarction with atrial fibrillation and left bundle branch block has a significant impact on both morbidity and mortality of patients. Patient Concerns: A middle-aged, married, heavy-smoking Egyptian male patient was admitted to the intensive care unit with acute chest pain with rapid atrial fibrillation, and left bundle branch block. Diagnosis: Left bundle branch block with atrial fibrillation and inferior Yasser’s criterion (Discrepancy criteria) ST-segment deviations as a new description in suspected acute myocardial infarction. Interventions: Electrocardiography, oxygenation, streptokinase IV infusion, and echocardiography. Outcomes: gradual, dramatic clinical and electrocardiographic improvement, but atrial fibrillation and left bundle branch block had occurred.
Lessons: Yasser’s criterion (Discrepancy criterion) is a new descriptive criterion for atrial fibrillation with aberrancy (atrial fibrillation and left bundle branch block). It is characterized by discrepant inferior ST-segment deviations with ST-elevation in III and aVR leads with ST-depression in II and aVF leads. It is an unknown mechanism. Both inferior infarctions of a single lead and pulmonary embolization are possible associations. It may be interpreted as accompanied by severe specific ischemic myocardial insult. Future wide-research studies for Yasser’s criterion (Discrepancy criterion) for sensitivity and specificity will be recommended.
