英文原文：
MyocardialInfarctioninthePresence
ofLeftBundleBranchBlockor
RightVentricularPacing
INTRODUCTION
Rapidandaccuratediagnosisofacutecoronaryocclusioniscriticalinpatientspresentingwithischemicsymptomstofacilitatetimelyinitiationofreperfusiontherapy.Earlyidentificationandsubsequentpatienttriageinindividualspresentingwithacutemyocardialinfarction(MI)isprimarilyreliantonthestandard12-leadECGwhenST-segmentelevationcriteriaareobserved.The12-leadECGisundoubtedlythemosteffectiveandinexpensivediagnostictesttodeterminethemanifestationofaMI,thelocationoftheculpritcoronarylesion,andtheseverityofongoingtissueinjury.However,recognitionofST-segmentelevationmyocardialinfarction(STEMI)inthepresenceofleftbundlebranchblock(LBBB)canbeparticularlydifficult.TraditionalelectrocardiographicalgorithmsusedtodiagnoseMIareineffectiveinpatientswithLBBB,thuslimitingtheacutediagnosticvalueofthe12-leadECGinthesepatients.
翻译
左束支传导阻滞或右心室起搏时
的心肌梗死心电图
引言：
急性冠脉综合征快速准确的诊断对缺血症状的患者至关重要，以便及时开始再灌注治疗。在出现急性心肌梗死（MI）的个体中，当ST段达到手术标准时，早期识别和随后的患者分诊主要依赖于标准的12导联心电图。无疑，12导联心电图是确定心肌梗死、罪犯血管定位和组织损伤的严重程度的最有效和最便宜的诊断检查。然而，存在左束支传导阻滞（LBBB）的情况下，识别ST段抬高心肌梗死（STEMI）可能特别困难。用于诊断MI的传统心电图标准在LBBB患者中无效，因此限制了这些患者中12导联ECG的急性诊断价值。
英文原文：
Inrecognitionofthesediagnosticchallenges,theandAmericanCollegeofCardiologyandAmericanHeartAssociation(ACC/AHA)STEMIguidelinesre