Related Experiment Videos
Painful left bundle branch block detected during dobutamine stress echocardiography
Stefano Ciaroni1, Philippe Urban
1Service de cardiologie, Hôpital de la Tour, Meyrin-Geneva, Switzerland.
Insights
A 50-year-old woman experienced sudden complete left bundle branch block and chest pain during dobutamine stress echocardiography. Subsequent tests for coronary artery disease were negative, suggesting a non-ischemic cause.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Imaging
Background:
- Dobutamine stress echocardiography is a standard test for evaluating coronary artery disease.
- Left bundle branch block (LBBB) can complicate stress testing.
- Anginal chest pain typically indicates myocardial ischemia.
Observation:
- A 50-year-old woman presented with simultaneous new-onset complete LBBB and anginal chest pain during dobutamine stress echocardiography.
- No abnormalities in left ventricular segmental contraction or wall thickening were observed.
- Extensive etiological investigations, including for coronary artery disease, yielded negative results.
Findings:
- The simultaneous occurrence of LBBB and anginal pain without wall motion abnormalities is unusual.
- Negative coronary artery disease workup suggests the symptoms were not due to significant epicardial coronary stenosis.
- This case highlights a potential dissociation between ischemic symptoms, ECG changes, and contractile dysfunction.
Implications:
- This observation may prompt re-evaluation of the diagnostic criteria for ischemia during stress echocardiography.
- Further research is needed to understand the mechanisms underlying this phenomenon.
- Consideration of non-coronary etiologies for LBBB and chest pain during stress testing is warranted.
Abstract:
We report on the observation, in a 50-year-old woman undergoing dobutamine stress echocardiography, of the simultaneous onset of complete left bundle branch block and anginal chest pain, unaccompanied by any abnormality of left ventricular segmental contraction or wall thickening. Further etiologic investigations, in particular for coronary artery disease, proved negative. This observation is discussed in the context of a literature review.