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[Unstable angina pectoris in intermittent left bundle branch block]
Praxis
|February 28, 1998
Summary
This case report details a patient whose chest pain was initially thought to be heart attack but was diagnosed as intermittent Left Bundle Branch Block (LBBB). This condition mimicked unstable angina, highlighting the importance of considering LBBB in chest pain evaluation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Chest pain is a common symptom requiring thorough investigation.
- Left Bundle Branch Block (LBBB) can present with symptoms mimicking acute coronary syndromes.
Observation:
- A 57-year-old woman presented with recurrent chest pain, initially exercise-induced and later at rest, leading to hospitalization for suspected myocardial infarction.
- Despite initial suspicion, enzymatic and electrocardiographic findings ruled out acute myocardial infarction; she was treated for unstable angina pectoris.
- Coronary angiography showed only mild coronary atheromatosis without significant stenosis.
Findings:
- The patient's symptoms were attributed to intermittent Left Bundle Branch Block (LBBB) with variable heart-rate dependency.
- This case highlights a rare presentation of LBBB mimicking unstable angina, with documented intermittent LBBB and heart-rate-dependent supranormal conduction.
Implications:
- Intermittent LBBB should be considered in the differential diagnosis of chest pain, even in the absence of significant coronary artery disease (CAD).
- Understanding the heart-rate dependency of LBBB is crucial for accurate diagnosis and management.
- This case contributes to the literature on LBBB presenting atypically without significant CAD.