Morning Report

Morning Report: LBBB

Presenter: Dr Kimberly Citarrella PGY-3

Case: 60 yo female presents after sudden onset chest pressure which woke her up from sleep. She was diagnosed with a new LBBB two weeks ago by her cardiologist and scheduled for an outpatient cath 3 days after she presented to the ER. Her recent echo showed EF of 25-30%. Her O2 saturation was 91% on room air and improved to 98% on 2L NC. She was treated with Lasix and admitted for cath procedure. 40 % stenosis found in pRCA. She improved and was discharged home.

Learning Points:

  • New LBBB were treated as AMI after studies showed many untreated LBBB had significant morbidity and mortality.
  • Sgarbossa criteria attempted to identify ACS in patients with known LBBB. This criteria has been modified with increasing sensitivity, but not specificity.
  • More recent studies have shown a lack of association between new LBBB and AMI and caution aggressive thrombolytic therapy in patients with considerable risk.

 

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