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    Human Health Campus
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    Typical chest pain with intermittent LBBB

    Teaching Case

    Case presentation:

    • Female.
    • 65 y.o.
    • No coronary risk factors.
    • Typical chest pain.
    • Normal rest ECG.
    • Exercise test: intermittent left bundle branch block (LBBB).
    • Exercise MPI (99mTc-MIBI): Frequency-dependent LBBB.

    Teaching points:

    • Approximately 1/3 of patients with heart failure (HF) present with conduction disturbances, most commonly (in about 25% of HF patients) as a LBBB pattern.
    • This percentage is significantly higher than the estimated (1.5%) prevalence of LBBB in the general population.
    • LBBB can be permanent or, more rarely, related to heart rate - that is, appearing above a frequency threshold.
    • Many patients with intermittent LBBB develop a permanent conduction disturbance in the long term. Repolarization changes are common in patients with LBBB, thus interfering with interpretation of stress tests.
    • Non-invasive imaging is indicated to depict ischemia in symptomatic patients with non-diagnostic ECG.
    • LBBB is commonly associated with perfusion defects at the anteroseptal and apical walls.
    • Frequency-dependet LBBB can cause “reversible” defects mimicking an ischemic pattern.

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