When a bundle branch block occurs, the site of the infarction is usually anteroseptal, and the infarct is often large. If the patient is known to have an old bundle branch or fascicular block. If the patient has a new left bundle branch block or bifascicular block associated with an MI, a temporary pacemaker is indicated. A bifascicular block is defined as the combination of a right BBB and a left anterior or posterior hemiblock. Can be demonstrated on echocardiogram or radionuclide ventriculogram.
Some authors recommend long-term anticoagulation to reduce the risk of embolization.
Surgical resection may be indicated for refractory LV failure, recurrent emboli despite anticoagulation, or medically refractory ventricular arrhythmias if electrophysiology studies indicate that the aneurysm may be the focus of the arrhythmia. Characterized by reelevation of cardiac enzymes and additional ECG changes. Patients with non-Q wave infarcts are at higher risk of extension of infarct in the 12 months after an MI than patients with transmural infarcts. For treatment and diagnosis, see section above. In the setting of an infarction, pericarditis usually occurs after a large transmural infarct.