CC BY-NC-ND 4.0 · Avicenna J Med 2013; 03(02): 50-52
DOI: 10.4103/2231-0770.114129
CASE REPORT

Intermittent left bundle branch block caused by coronary vasospasm

Mohammad Alhaji
Department of Hospital Medicine, Saint Joseph Mercy Health System, Ann Arbor, MI, USA
› Author Affiliations

Abstract

Intermittent left bundle branch block (LBBB) has been reported in the literature following certain conditions such as cardiac blunt trauma, myocardial infarction (MI) or exercise induced LBBB. In the majority of cases, the patients usually have underlying coronary arteries disease. LBBB often prevents the electrocardiographic diagnosis of acute MI; therefore, new LBBB in the setting of chest pain is usually treated as transmural MI. We describe a case of patient who presented with intermittent LBBB associated with chest pain, and subsequently the patient was taken to the catheterization laboratory for emergency coronary angiogram, which revealed 80% spasm in left anterior descending artery, which was totally relieved by nitroglycerin infusion. No other significant CAD was noted.



Publication History

Article published online:
09 August 2021

© 2013. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med 1959;27:375-88.
  • 2 Yilmaz A, Sechtem U. Angina pectoris without coronary stenosis - Current concepts. Dtsch Med Wochenschr 2010;135:1925-30.
  • 3 Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J. Role of coronary spasm in different anginal syndromes. Acta Med Scand Suppl 1985;694:83-94.
  • 4 Okumura K, Yasue H, Matsuyama K, Ogawa H, Kugiyama K, Ishizaka H, et al. Diffuse disorder of coronary artery vasomotility in patients with coronary spastic angina. Hyperreactivity to the constrictor effects of acetylcholine and the dilator effects of nitroglycerin. J Am Coll Cardiol 1996;27:45-52.
  • 5 Benzaquen BS, Cohen V, Eisenberg MJ. Effects of cocaine on the coronary arteries. Am Heart J 2001;142:402-10.
  • 6 Ogawa H, Yasue H, Oshima S, Okumura K, Matsuyama K, Obata K. Circadian variation of plasma fibrinopeptide A level in patients with variant angina. Circulation 1989;80:1617-26.
  • 7 Previtali M, Ardissino D, Barberis P, Panciroli C, Chimienti M, Salerno JA. Hyperventilation and ergonovine tests in Prinzmetal′s variant angina pectoris in men. Am J Cardiol 1989;63:17-20.
  • 8 Frisch DR, Zimetbaum PJ, Josephson ME. Alternating left bundle branch block and right bundle branch block during tachycardia: What is the mechanism? Heart Rhythm 2007;4:679-80.
  • 9 Calabrò MP, Cerrito M, Luzza F, Oreto G. Alternating right and left bundle branch block aberration during atrial tachycardia. J Electrocardiol 2009;42:633-5.
  • 10 Patanè S, Marte F, Di Bella G. Changing axis deviation with changing bundle branch block and new-onset of atrial fibrillation during acute myocardial infarction. Int J Cardiol 2009;132:e128-30.
  • 11 Pizzo VR, Beer I, de Cleva R, Zilberstein B. Intermittent left bundle branch block (LBBB) as a clinical manifestation of myocardial contusion after blunt chest trauma. Emerg Med J 2005;22:300-1.
  • 12 Patanè S, Marte F, Di Bella G. Atrial fibrillation with left bundle branch block and intermittent right axis deviation during acute myocardial infarction. Int J Cardiol 2008;127:e1-2.
  • 13 Eckart RE, Field ME, Hruczkowski TW, Forman DE, Dorbala S, Di Carli MF, et al. Association of electrocardiographic morphology of exercise-induced ventricular arrhythmia with mortality. Ann Intern Med 2008;149:451-60, W82.