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Intermittent left bundle branch block caused by coronary vasospasm

Mohammad Alhaji1

  • 1Department of Hospital Medicine, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.

Avicenna Journal of Medicine
|August 10, 2013
PubMed

Insights

Intermittent left bundle branch block (LBBB) can mimic acute myocardial infarction (MI). This case highlights coronary artery spasm as a cause of LBBB with chest pain, emphasizing the need for thorough investigation.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Intermittent left bundle branch block (LBBB) is a known but uncommon finding.
  • LBBB can complicate the diagnosis of acute myocardial infarction (MI).
  • Coronary artery disease (CAD) is often present in patients with LBBB.

Observation:

  • A patient presented with intermittent LBBB and chest pain.
  • Electrocardiogram (ECG) findings were consistent with LBBB.
  • New-onset LBBB in the context of chest pain typically warrants urgent evaluation for MI.

Findings:

  • Emergency coronary angiogram revealed severe (80%) spasm of the left anterior descending artery.
  • The coronary artery spasm was completely resolved with intravenous nitroglycerin.
  • No significant obstructive coronary artery disease was identified.

Implications:

  • Coronary artery spasm should be considered in the differential diagnosis of intermittent LBBB with chest pain.
  • This case underscores the importance of considering non-obstructive causes of chest pain and LBBB.
  • Aggressive diagnostic workup, including coronary angiography, is crucial in select cases to avoid misdiagnosis and ensure appropriate treatment.

Keywords:
Chest paincoronary vasospasmleft bundle branch block

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