Male with Long Standing Heart Failure and Left Bundle Branch Block with Acute Chest Pain: Is It Needed for Urgent Revascularization?

Authors

  • Fahmy Rusnanta Departement of cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
  • Mohammad Saifur Rohman Departement of cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia http://orcid.org/0000-0001-6461-2223
  • Setyasih Anjarwani Departement of cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
  • Ardian Rizal Departement of cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia http://orcid.org/0000-0002-9104-5022

DOI:

https://doi.org/10.21776/ub.hsj.2020.001.04.08

Keywords:

long standing heart failure, left bundle branch block, acute chest pain, revascularization

Abstract

BACKGROUND: Patients with acute heart failure and left bundle branch block (LBBB) presenting acute chest pain have many clinical challenges to perform diagnostic and therapeutic process. Recent recommendations stated that the patients with LBBB (new or presumably new) should be performed early revascularization, many of clinical controversies occur due to scientific gaps between current evidence and recommendations. It has led to reviewing other approach to assess this setting.

CASE SUMMARY: A 46-year-old man with previous history of dyspnea (long standing heart failure) came to our hospital with recurrent chest pain and acute heart failure. ECG showed LBBB suggesting acute myocardial infarction (excessive discordance in precordial lead). He had normal serial cardiac enzyme with on going ischemia symptom. He had been decided to not perform urgent reperfusion therapy. After five days hospitalization, he discharged home with medicines.

DISCUSSION:  This case report provides an example of reviewing existing algorithm to assess acute chest pain in congestive heart failure, regardless of ST segmen deviation in LBBB. Further research is needed to establish the clinical outcome for these patients underwent reperfusion strategy. 

References

Lettman NA, Sites FD, Shofer FS, Hollander JE. Congestive heart failure patients with chest pain: incidence and predictors of acute coronary syndrome. 2002;9(9):903-9.

Neeland IJ, Kontos MC, de Lemos JA. Evolving considerations in the management of patients with left bundle branch block and suspected myocardial infarction. 2012;60:96-105.

Bansilal S, Aneja A, Mathew V, et al. Long-term cardiovascular outcomes in patients with angina pectoris presenting with bundle branch block. Am J Cardiol. 2011;107:1565–70.

Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et.al. Left bundle-branck block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian Network on Congestive Heart Failure. American Heart Journal. 2002;143(3):398-405.

Jeger RV, Pfister O, Radovanovic D, Eberli FR, Rickli H, Urban P, et.al. Heart failure in patients admitted for acute coronary syndrome: A report from a large national registry. Clinical Cardiology. 2017;1-7.

Wilner B, de Lemos JA, Neeland IJ. LBBB in patients with suspected MI: An evolving paradigm. American College of Cardiology. Downloaded from https://www.acc.org/latest-in-cardiology/articles/2017/02/28/14/10/lbbb-in-patients-with-suspected-mi in April 20th, 2020.

Velazquez EJ, Pfeffer MA. Acute heart failure complicating acute coronary syndrome. Circulation. 2004;109:440-442.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et.al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2017;00:1-66.

Larson DM, Menssen KM, Sharkey SW, et al. “False-positive†cardiac catheterization laboratory activation among patients with suspected ST- segment elevation myocardial infarction. JAMA. 2007;298:2754–60.

Stepinska J, Lettino M, Ahrens I, Bueno H, Garcia-Castrillo L, Khoury A, et.al. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndrome. A position paper of ther Acute Cardiovascular Care Association. European Heart Journal: Acute Cardiovascular Care. 2020;9(1):76–89.

Van Den Berg P, Body R. The HEART score for early rule out of acute coronary syndromes in the emergency depart- ment: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2018;7: 111-9.

Kontos MC, Aziz HA, Chau VQ, Roberts CS, Ornato JP, Vetrovec GW. Outcomes in patients with chronicity of left bundle-branch block with possible acute myocardial infarction. Am Heart J. 2011;161:698 –704.

Andersen GN, Haugen BO, Graven T, Salvesen O, Mjolstad OC, Dalen H. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr 2011;12:665–70.

Heart Science Journal Volume 1-4, December 2020

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Published

2020-12-23

Issue

Vol. 1 No. 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Management

Section

Case Report

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