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( Franz Albert Go ),( Raul Jara ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Transient bundle branch block has been defi ned as an interventricular conduction defect that subsequently returns, to normal conduction. Of particular concern is the severe coronary artery disease etiology of this particular phenomenon which may have a diagnostic as well as prognostic value in such patients and may modify subsequent management strategies. Case: We present a case of transient left bundle branch block occurring in 60 year old female patient who presented with intermittent chest pain. First ECG on consult revealed sinus rhythm with complete left bundle branch block. A repeat ECG on follow up demonstrated an initial CLBBB pattern at lead 1 then reverting back to Narrow QRS sinus rhythm on the succeeding leads. Resting echocardiogram showed concentric left ventricular remodelling with normal wall motion, contractility and systolic function with grade 1 diastolic dysfunction. Dobutamine stress was performed revealing normal result with 88% MHR with no stress-induced ischemia. Hence, a coronary angiogram was done showing 3 vessel disease with signifi cant left main coronary involvement. She underwent CABG which remarkably improved her angina symptoms. Conclusions: This case report shows an unusual case of severe CAD presenting as transient CLBBB. The clinical presentation may be obvious clinically but certain diagnostic tests, particularly plain and stress echocardiogram, which can aid the physician in the diagnosis, may miss out the exact diagnosis. While a non-invasive echocardiogram is preferred over an invasive coronary angiogram for CAD workup, it is noteworthy to emphasize that a good history and physical examination with aid of conventional 12 lead ECG can guide physicians as to subsequent workup of this particular case.