Abstract
Introduction: Left bundle branch block can be seen in conditions like aortic stenosis, extensive coronary artery disease, primary disease of the cardiac electrical conduction system, dilated cardiomyopathy, Lyme disease; it is also associated with short left main coronary artery and dynamic left ventricular outflow tract obstruction. While the former is caused by the shearing force on septal branches of the left anterior descending artery, the latter is related to either Venturi effect in hypertrophic cardiomyopathy or effect of systolic anterior motion caused by abnormal geometric relationship of papillary muscle and the mitral apparatus.
Highlights
Left bundle branch block can be seen in conditions like aortic stenosis, extensive coronary artery disease, primary disease of the cardiac electrical conduction system, dilated cardiomyopathy, Lyme disease; it is associated with short left main coronary artery and dynamic left ventricular outflow tract obstruction
While the former is caused by the shearing force on septal branches of the left anterior descending artery, the latter is related to either Venturi effect in hypertrophic cardiomyopathy or effect of systolic anterior motion caused by abnormal geometric relationship of papillary muscle and the mitral apparatus
Int J Case Rep Images 2015;6(3):156–160. www.ijcasereportsandimages.com outflow tract (LVOT) obstruction [1]. While the former is caused by the shearing force on the septal branches of the left anterior descending artery, the latter is related to these major possibilities among others: the Venturi effect in hypertrophic cardiomyopathy (HCM) as well as systolic anterior motion of the mitral valve (SAM) generated largely by drag effect, that is hydrodynamic pushing force of flow directly on the leaflets, and the SAM caused by abnormal geometric relationship of papillary muscle and the mitral apparatus
Summary
Left bundle branch block (LBBB) is a common finding in conditions such as aortic stenosis, extensive coronary artery disease, primary disease of the cardiac electrical conduction system, dilated cardiomyopathy, Lyme disease; it can be associated with short left main coronary artery (LMCA) and a dynamic left ventricular. A coronary angiogram was done, showing a short left main coronary artery (Figure 2), while a stress ECHO revealed a significant dynamic LVOT obstruction (chordae tendineae SAM) with a gradient of 40.9 mmHg (Figure 3) at the end of a third dose with symptoms that prompted the termination of the test. He was discharged on beta blocker (bisoprolol 5 mg daily) management and has reported great improvement in his functional capacity.
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