The Significance of a New Right Bundle Branch Block in a Patient with Acute Chest Pain

Background : Patients with acute heart failure and left bundle branch block (LBBB) presenting acute chest pain have many clinical challenges to perform the diagnostic and therapeutic process. Recent recommendations revealed that the patients with LBBB (new or presumably new) should be performed early revascularization. However, several clinical controversies occurred due to scientific gaps between current evidence and recommen- dations. Therefore, the review of other approaches to assess this setting might be required. Objective : This case report aims to describe factors related to early revascularization strategy in patients with long standing heart failure and left bundle branch block. Case : A 46-year-old man with the previous history of dyspnea (long-standing heart failure) was admitted to our hospital with recurrent chest pain and acute heart failure. Electrocardiogram (ECG) showed LBBB suggesting acute myocardial infarction (excessive discordance in the precordial lead). He had normal serial cardiac enzymes with ongoing ischemia symptoms. He had been decided not to perform urgent reperfusion therapy. After five days of hospitalization, he discharged home with medicines. Our case report provided an example of applying the existing algorithm to assess acute chest pain in congestive heart failure, regardless of ST-segment deviation in LBBB. Conclusion : Clinical judgement and the use of objective findings offer the best way to determine the need for early reperfusion in our case.

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Annals Consult Guys - New Right Bundle Branch Block and Newly Diagnosed Alzheimer's: What to Do?

Annals of Internal Medicine ◽

10.7326/w18-0027 ◽

2018 ◽

Vol 169 (12) ◽

pp. CG1

Author(s):

Geno J. Merli ◽

Howard H. Weitz

Keyword(s):

Right Bundle Branch Block ◽

New Right ◽

Newly Diagnosed ◽

Bundle Branch Block

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Transient Brugada phenocopy during evolving ischemic right bundle branch block

Case Reports in Internal Medicine ◽

10.5430/crim.v4n1p8 ◽

2016 ◽

Vol 4 (1) ◽

pp. 8 ◽

Cited By ~ 1

Author(s):

Federico Ferrando-Castagnetto ◽

Alvaro Rivara ◽

Gustavo Vignolo ◽

Roberto Ricca-Mallada ◽

Adrián Baranchuk

Keyword(s):

Right Bundle Branch Block ◽

Acute Chest Pain ◽

Drug Eluting Stent ◽

Bundle Branch Block ◽

St Segment Elevation ◽

St Segment ◽

Clinical Scenarios ◽

Acute Myocardial Injury ◽

Drug Eluting ◽

Block Pattern

A “Brugada phenocopy” (BrP) is a clinical presentation exhibiting the same electrocardiographic characteristics of true Brugada syndrome (BrS) in different clinical scenarios. We report the clinical case of a 59-year-old male patient with acute chest pain depicting BrP followed by extensive convex ST-segment elevation due to proximal thrombosis of the left descending coronary artery. Following successful percutaneous intervention and drug-eluting stent implantation, a classical right bundle branch block pattern emerged. We discussed possible mechanism and clinical implications of this unusual electrical sequence during acute myocardial injury.

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