Question Title: BBB

A neurologist friend of mine intimated that a BBB (bundle branch block) could be part of a more generalized inflammatory process. Would you agree with this statement and if so, what testing, if any, would you recommend to determine the overall risk factor. The patient is a 33 yo w male, 30#'s overweight, non smoker/drinker. Pt. describes high stress factors in work and is very sedentary. He claims he does not exercise 2nd to severe fatigue (dx CFS in 1988 by ER doc seemingly based on lack of findings on routine serum labs)
Pt. has also c/o transient chest pain radiating to shoulders, neck and back over a period of 12 months. Pt's mood affect and sensorium are intact. No meds. Family history notable for cardiomyopathy.

BBB picked up on routine EKG

Your input is appreciated.

Thanks

Tracy

Dear Tracy

Some people are born with a BBB, and it is of no significance. In some patients, it represents underlying heart disease, such as cardiomyopathy or coronary artery disease. Given the family history of cardiomyopathy and the extreme fatigue, an echocardiogram would rule out the possibility of a cardiomyopathy. A stress test with a concomitant imaging modality such as echo would be useful to evaluate whether the chest pains are cardiac in origin.

I hope this has been useful. I wish you the best of luck.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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