Subscribe to Resus
Get the latest updates on our Conferences PLUS our Webcasts and Education Newsletters. And it's FREE!
Register Now:
Here’s the case. You see a 24 year old male who presents with a history of 2 minutes of pinpoint left chest pain 12 hours earlier. He has not had any pain since. At that time there was no shortness of Breath or radiation of the pain. The patient has no past medical history, is on no medications and has a normal clinical examination. The nurse performs an ECG and shows it to you. It is a Left Bundle Branch Block(LBBB). You actually feel a bit nervous about it and perform a troponin, which is normal. What do you do now?
In a 2005 study (Mayo Clin Proc) Miller et al., performed a retrospective study of 723 patients. Almost half of the patients had left bundle branch block(LBBB), the other half had right bundle branch block. Those patients with any form of bundle branch block and no complicating factors such as diabetes, hypertension or hypercholesterolaemia, had increased long term mortality compared to controls. Those with LBBB showed an increased risk of cardiac related morbidity. This has been found in many other epidemiological studies.
Littman (J Electrocardiol, 2000) looked at the effects of LBBB and found that it can cause asynchronous myocardial activation which may trigger ventricular remodelling. It is also associated with impaired systolic and diastolic function.
So what to do?
In this patient, who is well, with atypical and short-lived chest pain and a normal troponin, it is important to have follow up. This should take the form of an outpatient echocardiogram looking for valvular abnormalities or cardiomyopathy. If this is normal, then there is not much else to do, except to follow up over periods of time.
If there was any issue of coronary artery disease then the patient should also have a stress/thallium study.
54 Comments
Leave a Comment
Subscribe for FREE regular updates in your inbox.
Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Popular Posts
Paediatric Pearls
Treating the Hypoxic COVID-19 Patient: Can low flow systems be improved?
Cardiogenic Shock: Which Vasopressor to use
The U wave and the ECG: Don’t miss this
Is Ventricular Bigeminy Benign? Which Patients Need treatment?
5 Things you Must do when Patients Present with Syncope
11 Things to Maximise Adult Cardiac Resuscitation
Your style is so unique compared to other folks I have
read stuff from. Thanks for posting when you’ve
got the opportunity, Guess I will just book mark this blog.
Wow! This can be one particular of the most useful blogs We have ever arrive across on this subject.
Basically Excellent. I am also a specialist in this topic therefore I
can understand your effort.
Look at my site TestoXmen
Thanks a bunch for sharing this with all people you really recognise what you are speaking approximately!
Bookmarked. Please additionally talk over with my site =).
We could have a link exchange contract among us
my webpage … Pure CBD Softgels Reviews (http://vip5.moisait2021.ru/)
Appreciate the recommendation. Let me try it out.
Feel free to visit my website – Ultra Quick Keto Burn Reviews (http://www.meteoritegarden.com)
I really enjoy looking at on this internet site, it has fantastic content.
Also visit my site: Bioneo Farms Pure CBD; fles.hlc.edu.tw,
It’s a shame you don’t have a donate button! I’d certainly
donate to this brilliant blog! I suppose for now i’ll settle for book-marking and adding your RSS feed to my Google
account. I look forward to fresh updates and
will share this site with my Facebook group. Chat soon!
Good blog! I really love how it is simple on my eyes and the data are
well written. I am wondering how I might be notified whenever
a new post has been made. I have subscribed to your feed which must do the trick!
Have a great day!
Feel free to visit my site – Ultra Quick Keto Cleanse
I was just searching for this info for a while. After six hours of continuous Googleing, at last I
got it in your web site. I wonder what’s the lack of Google strategy
that don’t rank this type of informative websites in top of the list.
Usually the top web sites are full of garbage.
Feel free to visit my website: Extreme Muscle XXL Ingredients
Thank you a lot for providing individuals
with remarkably superb opportunity to check tips from this site.
It really is very enjoyable and as well , full of fun for
me personally and my office acquaintances to visit your blog at least thrice in a
week to see the newest things you have got. Of
course, I am just always impressed concerning the awesome
tips served by you. Certain 2 points on this page are clearly the most beneficial we have had.
Also visit my homepage – Renew Brite Advanced Teeth Whitening (http://www.meteoritegarden.com)
Hello, I want to subscribe for this webpage
to obtain newest updates, so where can i do it please help out.
With havin so much contｅnt and articles dо you ever run into any issues
of plagorism or copyright infringement? My blog hаs a llot oof unique
contеnt I’ve either authored myself or outsourced but it seems a lot of it is poppіng itt ᥙup all over the web without
mʏ agreement. Do you know any techniques to help
protect against content from being stolen? I’d enuinely
aрpreciate it.
Thanks in support of sharing such a good thought, article
is nice, thats why i have read it completely
Have a look at my web site … GrownMD CBD
Hello, after reading this amazing article i am too
cheerful to share my familiarity here with friends.
Thank you so much for providing individuals with
a very spectacular possiblity to read from this site.
It’s always so pleasurable plus jam-packed with amusement for me personally and my office colleagues
to search your blog the equivalent of three times a week to read the
new issues you will have. And definitely, I’m also usually impressed with all the awesome ideas you give.
Selected two facts in this post are basically the simplest
we’ve ever had.
Also visit my web blog … Tundra Breeze Portable Air Conditioner
Simply want to say your article is as surprising. The clarity in your publish is simply excellent and that i can think
you’re a professional in this subject. Well together with your permission allow me to take hold of your feed to stay
up to date with impending post. Thanks a million and please carry on the enjoyable work.
I blog often and I seriously thank you for your information. The article has truly
peaked my interest. I am going to book mark your website
and keep checking for new details about once a week.
I subscribed to your RSS feed as well.
Keep up the fantastic work, I read few articles on this internet site and I believe that your
blog is really interesting and contains bands
of good information.
My blog; Erectesto XL Male Enhancement
Good website! I really love how it is easy on my eyes and
the data are well written. I am wondering how I could be notified when a new post has been made.
I have subscribed to your RSS which must do the trick! Have
a great day!
my website – Max Melt Keto
I consider something really interesting about your
web blog so I saved to fav.
Feel free to visit my web-site :: Mega Male Enhancement Review
I enjoy, lead to I found just what I was having a look for.
You’ve ended my 4 day lengthy hunt! God Bless you man. Have a great day.
Bye
Feel free to visit my homepage … Erectesto XL Ingredients
Wow, amazing blog layout! How long have you been blogging for?
you make blogging look easy. The overall look of your site is great, as well as the content!
Feel free to visit my blog post: Max Melt Keto
Spot on with this write-up, I honestly believe that this website needs much
more attention. I?ll probably be returning to see more, thanks
for the info!
My web site A1 Keto BHB Reviews
Thank you a lot for providing individuals with an exceptionally special chance to read articles
and blog posts from here. It’s always very fantastic
and also jam-packed with a good time for me personally and my office
peers to visit your website the equivalent of three times in one week to see the latest issues you have.
And indeed, I am usually impressed with your dazzling tips you serve.
Some 1 points in this post are basically the most impressive we have all ever had.
my web blog; UltraXTend Review
My brother recommended I might like this web site.
He was totally right. This post actually made my day.
You cann’t believe simply how a lot time I had spent for this information! Thanks!
my page :: Pure CBD Softgels Cost
I’ll right away seize your rss feed as I can not find your e-mail subscription link or newsletter service.
Do you have any? Please permit me realize in order that I could
subscribe. Thanks.
Look into my blog post – Terra Xtract CBD Reviews
Hi, this weekend is nice for me, since this occasion i am reading this fantastic educational piece of writing here at my house.
Look into my site Keto X3 (http://www.meteoritegarden.com)
I was curious if you ever thought of changing the page layout of your site?
Its very well written; I love what youve got to say. But maybe
you could a little more in the way of content so
people could connect with it better. Youve got an awful lot of text for only having one or two
images. Maybe you could space it out better?
Stop by my blog post GrownMD CBD Review
Hello There. I found your blog using msn. This is a very well written article.
I will make sure to bookmark it and come back to read
more of your useful info. Thanks for the post. I will definitely return.
Hi there, this weekend is pleasant for me, because this occasion i am reading
this impressive educational paragraph here at my residence.
Hurrah, that’s what I was exploring for, what a data!
present here at this webpage, thanks admin of this web
page.
Review my homepage Mega Male Enhancement Pills
I’m gone to inform my little brother, that he should also go to see this website on regular basis to get updated from
hottest gossip.
Take a look at my web site: Quick Keto Trim Ingredients
Right now it sounds like Expression Engine is the
preferred blogging platform out there right now.
(from what I’ve read) Is that what you are using on your blog?
Also visit my blog post … Extreme Keto EFX Ingredients
I have been browsing online more than 4 hours today, yet I never found any interesting
article like yours. It’s pretty worth enough for me.
In my opinion, if all site owners and bloggers made good content as you did,
the web will be a lot more useful than ever before.
My website – Extreme Keto EFX Pills
Every weekend i used to visit this web site, for the reason that i wish for enjoyment,
as this this site conations really good funny material too.
When I originally commented I clicked the “Notify me when new comments are added” checkbox and now each time a comment is added I
get several emails with the same comment. Is there any way you
can remove people from that service? Appreciate it!
Great blog here! Also your website loads up fast!
What host are you using? Can I get your affiliate link to your host?
I wish my website loaded up as fast as yours lol
Can you tell us more about this? I’d want to find out some additional information.
Feel free to visit my web blog – Bioneo Farms CBD Review
Great post. I was checking continuously this blog and I am inspired!
Very helpful info specifically the final phase 🙂 I maintain such info a lot.
I used to be seeking this certain info for a long time. Thank you and good luck.
I savour, lead to I discovered just what I was looking for.
You’ve ended my four day long hunt! God Bless you man. Have a
great day. Bye
My spouse and I absolutely love your blog and find almost all of your post’s to be precisely what I’m looking for.
can you offer guest writers to write content for yourself?
I wouldn’t mind producing a post or elaborating on a few
of the subjects you write about here. Again, awesome website!
Good info. Lucky me I came across your site by chance (stumbleupon).
I have bookmarked it for later!
Unquestionably believe that which you said. Your favorite justification seemed to be on the net the easiest
thing to consider of. I say to you, I definitely
get annoyed while folks think about worries that they just do not realize
about. You controlled to hit the nail upon the highest as neatly as outlined out
the whole thing with no need side effect ,
folks can take a signal. Will likely be back to get more.
Thanks
I really like what you guys tend to be up too. This kind of clever work and
exposure! Keep up the fantastic works guys I’ve added you guys to my own blogroll.
Hey very nice blog!
Hi! I could have sworn I’ve been to this blog before but after reading
through some of the post I realized it’s new to
me. Nonetheless, I’m definitely glad I found it and I’ll be book-marking and checking back often!
If you desire to improve your know-how just keep
visiting this website and be updated with the most recent news update
posted here.
This paragraph is truly a good one it assists new web visitors, who are
wishing for blogging.
Google
One of our visitors not long ago suggested the following website.
taurus 454 raging bull
[…]Here are some of the web sites we advise for our visitors[…]
springfield saint edge for sale
[…]below youll come across the link to some websites that we believe you need to visit[…]
sig p938 for sale
[…]Here is a good Blog You may Come across Exciting that we Encourage You[…]
taurus 92fs stainless
[…]here are some links to web-sites that we link to due to the fact we believe they may be really worth visiting[…]
deckmate shuffler
[…]Sites of interest we’ve a link to[…]
mossberg 500a for sale
[…]very handful of web-sites that transpire to become in depth beneath, from our point of view are undoubtedly well really worth checking out[…]