We know new onset LBBB creates considerable anxiety . We experienced a reverse situation recently . A 72 year old man who is known to have chronic LBBB for over 5 years came to CCU with vague chest discomfort .
His ECG was perfectly normal . . . every one was curious !
My ECG always looked like this doctor ! Now you say it has normalised and you say it concerns you ! I am really worried doctor !
What does it mean doctor ?
Cardiologist : I do not know . Any sudden change in rhythm even if it is from abnormal to normal is to be given importance .
Patient : Is the going bad ?
Cardiologist : I do not know
Patient : Should I get admitted ?
Cardiologist : I think so but you need to undergo few blood tests and repeat an ECG .
Patient : Oh what ? you are not sure either ! Are you not an expert in heart disease doctor ?
Cardiologist : I think I am . I wish I have an answer to your question .
This patient was admitted in intermediate care ward and observed for 12 hours .
His enzymes and Troponin were negative . Echo showed normal LV function .
He was discharged later and adviced a stress test .
What is the the mechanism of normal ECG here ?
Intermittent LBBB due to rate dependency is common .But this man had persistent chronic LBBB for > 5 years which got normalized .That mystified us !
Can transient ischemia of left bundle accelerate the conduction ?