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The Way To A Healthy Heart

Left Bundle Branch Block

Dear Doctor

My relative, 44 years age, office job, had one episode of chest pain few days back. No other complaints. He also has mild hypertension. No other medical or surgical history. I have sent you the ECG. Please see and opine. Thanks.

(Dr Tarun D., Mumbai)

Dear Dr Tarun D.,

Please go through the KNOWLEDGE CENTER ( especially the section on STRUCTURE OF HEART) on this website The ECG sent by you shows LEFT BUNDLE BRANCH BLOCK (LBBB), a condition where the conduction system of heart (the circuit) becomes weak on the left side, so that the stimulation (and hence contraction) of left ventricle lags significantly behind that of right ventricle (in normal hearts, both occur almost simultaneously).  Various heart diseases can cause this problem at your uncle's age includind coronary artery disease, heart valve disease, conduction system disease, cardiomyopathy etc. 


In view of the risk factors (hypertension, sedentary job) and history of chest pain, it would be better to get your relative evaluated for coronary artery disease (CAD). CAD is now commonly seen in his age group.

First get an echocardiography of heart done. If it is normal, he should undergo stress thallium or dobutamine stress echocardiography or CT coronary angiography. If one of these is abnormal, he will need conventional coronary angiography. But if echocardiography is abnormal, he will need treatment according to the disease detected. 

Discuss these points with your cardiologist and follow his opinion.(Please see disclaimer*)

Hope this helps.

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OK doctor.


Dear Dr Tarun D.,
I feel that despite a normal echocardiography (which rules out most of the causes of LBBB), the LBBB at this age should not be ignored. I feel he should undergo:
• Stress thallium or a coronary CT angiography to rule out CAD.
• ESR, to rule out any autoimmune disease (diseases caused by body’s own overactive defence mechanisms).
Even long standing hypertension can cause LBBB. So, even if all reports come normal, still he needs to follow up with a cardiologist or at least a physician regularly to monitor /control BP and to get an ECG and an echocardiography done (at least once a year) as LBBB patients have been shown to have poorer prognosis in long term than normal individuals.

Let me know the progress..(PLEASE SEE DISCLAIMER*)


Dear Doctor
My relative’s echocardiography report is normal. What do you suggest now?
(Dr. Tarun D.)