Painful Left Bundle Branch Block Syndrome Diagnosed in the Emergency Department

Area of Science:

• Cardiology
• Emergency Medicine
• Medical Diagnostics

Background:

• Nonischemic angina associated with intermittent left bundle branch block (LBBB) is recognized in cardiology as "painful left bundle branch block syndrome."
• Existing literature primarily comprises case series, outlining proposed pathophysiology, diagnostic criteria, and therapies.

Purpose of the Study:

• To highlight a case of painful left bundle branch block syndrome presenting to the emergency department.
• To increase emergency physician awareness of this rare but significant condition.
• To review the current understanding of the syndrome's pathophysiology, diagnostics, and treatment.

Main Methods:

• Case report presentation of a patient with intermittent chest pain and LBBB.
• Review of existing medical literature on painful LBBB syndrome.
• Emphasis on the diagnostic utility of smartwatch and electrocardiogram data.

Main Results:

• The case illustrates a patient diagnosed with painful LBBB syndrome.
• The review consolidates proposed pathophysiology, diagnostic features, and therapeutic strategies.
• The syndrome is notably absent from current emergency medicine literature.

Conclusions:

• Painful left bundle branch block syndrome is an underrecognized cause of chest pain in the emergency department.
• Emergency physicians require awareness of this syndrome for timely diagnosis and appropriate management.
• Further research may be warranted to establish definitive diagnostic and treatment guidelines.