scholarly journals 539 Frequency related left bundle branch block as cause of chest pain: ‘painful LBBB syndrome’

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giulia Stronati ◽  
Lorenzo Torselletti ◽  
Alessia Urbinati ◽  
Giuseppe Ciliberti ◽  
Alessandro Barbarossa ◽  
...  
Keyword(s):  
Heart Rate ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Sinus Rhythm ◽  
Left Bundle Branch Block ◽  
Beta Blockers ◽  
Recovery Phase ◽  
Bundle Branch Block ◽  
Stenotic Lesion ◽  
Typical Chest Pain

Abstract Aims A 47-years-old man presented to our cardiology ambulatory due to sudden chest pains, mainly on exertion. His only relevant cardiovascular risk factor was a familiarity for coronaropathy. In 2013 he had undergone a coronary angiography which was negative for stenotic lesions. Since then he was treated with beta-blockers and Ivabradine with mild improvement of the pain. Methods and results While his previous Holter-ECG reported sinus rhythm [heart rate (HR) 60 b.p.m.] and no alterations of atrioventricular nor of interventricular conduction, his ECG during his examination in our ambulatory showed sinus rhythm (HR 80 b.p.m.), normal atrioventricular conduction but presence of complete left bundle branch block. We therefore performed an ergometric test. His baseline ECG (HR around 65 b.p.m.), at the start of the test, showed no left bundle branch block and the QRS complex was narrow. During the test, at the heart rate of around 85 b.p.m., the ECG showed a complete left bundle branch block. At the same time the patient complained of typical chest pain. The ergometric test was submaximal as it was stopped at the beginning of the third Bruce stage due to the patient’s chest pain. No ST segment alterations were found. During the recovery phase, we noted that the left bundle branch block disappeared when the heart rate was below 75 b.p.m. A new coronary angiography was performed and again it showed no stenotic lesion. We therefore concluded our diagnostic workup and diagnosed a frequency related ‘painful left bundle branch block syndrome’. Conclusions ‘Painful left bundle branch block syndrome’ is defined as the presence of typical chest pain together with left bundle branch block, in the absence of signs of myocardial ischaemia. The pain improves once the conduction defect disappears. The mechanism of the syndrome is not known although it seems to be related to dyssynchrony of the myocardium. It may often be frequency related.

scholarly journals Image quality of 16-slice computed tomography coronary angiography in patients with complete left bundle branch block

Medicina ◽  
2008 ◽  
Vol 45 (1) ◽  
pp. 14
Author(s):  
Antanas Jankauskas ◽  
Jurgita Zaveckienė ◽  
Gabija Pundziūtė ◽  
Rimvydas Šlapikas ◽  
Algidas Basevičius ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Heart Rate ◽  
Image Quality ◽  
Coronary Angiography ◽  
Left Bundle Branch Block ◽  
Multislice Computed Tomography ◽  
Quality Score ◽  
Control Group ◽  
Bundle Branch Block

Objective. Noninvasive diagnosis of coronary artery disease in patients with left bundle branch block is challenging. Multislice computed tomography can be useful in this population; however, quality of images depends on the patterns of myocardial contractions. We investigated the influence of left bundle branch block on image quality of multislice computed tomography coronary angiography. Materials and methods. Multislice computed tomography coronary angiography was performed in 30 patients with left bundle branch block and 30 patients without conduction disturbances. Image quality of each coronary segment was visually assessed and rated on a five-point scale (1=highest quality). Results. Average image quality score in the best cardiac cycle phase did not differ significantly between groups (1.71±0.59 in the left bundle branch block group vs. 1.60±0.57 in the control group, P=0.46). In the left bundle branch block group, a significantly lower image quality score was observed in end-systolic cardiac phase (2.67±0.6 vs. 2.22±0.65 in the control group, P=0.007), whereas no difference was demonstrated in mid-diastolic phase (1.73±0.6 vs. 1.69±0.66 in the control group, P=0.81). After image assessment in multiple cardiac phases, an increase in image quality score was higher in the left bundle branch block than in the control group (0.2±0.17 vs. 0.11±0.14, P=0.003). A negative correlation was observed between image quality score and both the heart rate and heart rate variability in both groups (P<0.001). Conclusion. A nonsignificantly lower overall image quality of multislice computed tomography coronary angiography was demonstrated in the left bundle branch block group. In the presence of left bundle branch block, image quality in the end-systolic phase was significantly lower. Image assessment in multiple phases increased overall image quality and is therefore advisable in patients with left bundle branch block. Increased heart rate and heart rate variability worsened image quality in both groups.

scholarly journals Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001425
Author(s):  
Marc Meller Søndergaard ◽  
Johannes Riis ◽  
Karoline Willum Bodker ◽  
Steen Møller Hansen ◽  
Jesper Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Heart Rate ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

scholarly journals Elevated troponin and left bundle branch block in the setting of suspected septicemia and demand ischemia: to treat or not to treat

2018 ◽  
Author(s):  
Munish Sharma ◽  
Rubinder Toor ◽  
Koroush Khalighi
Keyword(s):  
Chest Pain ◽  
Left Bundle Branch Block ◽  
Cardiac Monitoring ◽  
Type Ii ◽  
Elevated Troponin ◽  
Cardiac Enzymes ◽  
Atypical Chest Pain ◽  
Bundle Branch Block ◽  
Coronary Catheterization ◽  
St Elevation

Elevated troponin and atypical chest pain in the setting of septicemia and Type II Non ST elevation myocardial infarction is frequently encountered. These cases are not necessarily scheduled for emergent cardiac catheterization. High index of clinical suspicion and continuous in-patient cardiac monitoring with serial trending of cardiac enzymes are important in such cases. Subsequent sudden development of electrocardiogram changes requires prompt investigation with emergent coronary catheterization. These types of cases may be missed especially in females who present with atypical chest pain and in patients with Left bundle branch block.

HFrEF pharmacological treatment: ivabradine

ESC CardioMed ◽  
2018 ◽  
pp. 1863-1867
Author(s):  
Michel Komajda
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Pharmacological Treatment ◽  
Beta Blockers ◽  
Reduced Ejection Fraction ◽  
Background Therapy

Ivabradine slows down the heart rate through a blockade of the funny current channels in the sinoatrial node cells. The efficacy of the drug was tested in a large outcome clinical trial in stable chronic heart failure with reduced ejection fraction, in sinus rhythm, on a contemporary background therapy including beta blockers.

scholarly journals Differential effect of regadenoson versus dipyridamole on heart rate in patients with left bundle branch block: How does it affect the results of pharmacological nuclear stress testing?

2019 ◽  
Vol 8 ◽  
pp. 204800401982825 ◽  
Author(s):  
Mahmoud Assaad ◽  
Abeer Berry ◽  
Jaishree Palanisamy ◽  
Joseph Fenner ◽  
Marcel Zughaib
Keyword(s):  
Heart Rate ◽  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Left Bundle Branch Block ◽  
Rate Increase ◽  
Stress Test ◽  
Vasodilator Agents ◽  
Heart Rate Increase ◽  
Peak Heart Rate ◽  
Bundle Branch Block

Background Myocardial perfusion imaging (MPI) stress test is performed either using exercise as a stress modality or through the use of pharmacological vasodilator agents in those who cannot exercise. Regadenoson and dipyridamole are some of the most common vasodilator agents used. We aim to study the effect of these agents on the heart rate and the imaging results. Methods This was a retrospective study which included 187 patients with left bundle branch block. Patients received either dipyridamole or regadenoson during the myocardial perfusion imaging stress test. Charts were reviewed, and patient characteristics were recorded, as well as baseline heart rate, peak heart rate during stress, and angiographic data if available. Results Regadenoson increased peak, absolute and relative heart rates significantly more compared to dipyridamole. The peak heart rate for Regadenoson was 94.1 ± 17.36 and for dipyridamole it was 85.38 ± 16.48 BPM (P < 0.001). The relative and absolute heart rate increase in the regadenoson group were 40.75 ± 23.01% and 26.06 ± 13.44 BPM, respectively. The relative and absolute heart rate increase in the dipyridamole group were 24.61 ± 18.25% and 16.23 ± 10.97 BPM. The frequency of reversible septal defects was similar in both groups (54% for Regadenoson vs. 63% for Dipyridamole; P = 0.24). Conclusions There is a statistically significant increase in heart rate with the use of regadenoson for MPI compared to dipyridamole. However, the number of septal perfusion defects was similar between the two groups. The effect of this increase in heart rate, while statistically significant, is likely of no clinical significance.

Exercise-induced left bundle branch block accompanied by chest pain

2004 ◽  
Vol 37 (4) ◽  
pp. 325-328 ◽  
Author(s):  
Andreas P. Michaelides ◽  
Athanasios N. Kartalis ◽  
Maria-Niki K. Aigyptiadou ◽  
Pavlos K. Toutouzas
Keyword(s):  
Chest Pain ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Exercise Induced

scholarly journals Is thrombolytic therapy indicated in all patients having chest pain and left bundle branch block?

1998 ◽  
Vol 31 ◽  
pp. 269
Author(s):  
M.C. Kontos ◽  
R.L. Jesse ◽  
J.l. Tatum ◽  
C.S. Roberts ◽  
K.L. Schmidt ◽  
...  
Keyword(s):  
Chest Pain ◽  
Thrombolytic Therapy ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block
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