Exercise Induced Left Bundle Branch Block Treated with Cardi
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The patient was a 42-year-old woman who presented with exertional chest pain, palpitations, and dyspnea that resolved with rest. She had a normal physical exam and her only medication was an oral contraceptive. 12-lead electrocardiogram was normal with the following intervals: PR interval was 154 millisecond, QRS was narrow at 82?msec, and QT interval was normal at 392?msec, corrected QT using Bazett's formula was 431?msec. Laboratory tests including hemoglobin and cardiac troponin T were normal.

She was referred for exercise stress testing using the Bruce protocol during which she developed a left bundle branch block (LBBB) with a QRS duration of 120?msec at a heart rate of 112 beats per minute (bpm). During the aberrant conduction and at peak exercise, her symptoms of chest pain and palpitations returned. She was able to exercise through her discomfort, reaching a peak heart rate of 171?bpm and 10.4 metabolic equivalent (MET) at 9?:?11?min of exercise. The test was stopped due to limiting chest discomfort that persisted until her heart rate returned to 100?bpm at 2?:?30?min of recovery and normal conduction was restored. An echocardiogram was performed and revealed no structural abnormalities other than a small patent foramen ovale (PFO). Concerns regarding ischemia as the etiology for her conduction abnormalities prompted coronary angiography that demonstrated normal coronary arteries with no evidence of atherosclerosis.....

Dr. H●●●●h P●●●l and 6 others like this
Dr. M●●●●●v D●●●i
Dr. M●●●●●v D●●●i Internal Medicine
Oral contraceptives have obviously to be omitted. I would still consider ischemia as the underlying etiology for LBBB, keeping close observation, Statins, Aspirin, and elective option of AICD.
Apr 19, 2017Like