LBBB treatments

[Financelady]

My husband recently went to the emergency room with chest pains and shortness of breath. They performed an EKG onsite and found abnormal LBBB. We were admitted they ran various enzyme testing, stress test, demps isotope testing, ECG ultra sound and found that he was not getting enough oxygen to his lower heart. We then had a heart cath done the next day and the cardiologist came out to tell me that there were no blockages and the heart appeared free from disease. I cannot seem to understand how the EKG reading before and after were abnomal, my husband still has pain and they sent us home with nothing as if everything is fine. Resting BPM is 50, BPM when sleeping is 40 and his heart rate was spiking during the stress test to over 185 BPM. Do I need to seek another opinion or have I done all I can do? What's normal or am I just being overly sensitive. Should I take the heart cath results as the finality. We have another appointment with the cardiologist in 2 weeks but I am none too happy.  He presents all symptoms of a serious electrical problem with fatigue and tiredness needing to take several naps a day. I need to know if LBBB can lead to a fatal heart attack. 41 year old male 220 pounds, 6' 2inches tall.

[karinosa]

Thanks for the info, I just hope at some point I'll either get better or the doctors will figure out why I'm sick, since they say it is not due to my heart.

Take care,

Karin

[kenkeith]

Karin,

A cath angiogram takes images of the lumen (channel for vessel blood flow) looking for blockage, etc.  

The highest risk for a heart attack is the soft plaque that forms between layers of the vessel composition. If and when the soft plaque breaks through (ruptures) into the lumen, the risk is high for the resulting clot to cause a heart attack.

CT scan 64-slice (the best) angiogram takes images of the vessel anatomy and analyzes and even predicts the probability of heart attack with a certain time fram based on the calculated calcium count (scoring).  I had the test a couple of months ago.

If your vessels look good with a cath, the probability of soft plaque formation may be low.

[kenkeith]

To test the heart's electrical activity requires leads to be placed on the chest to capture the impulse in real time.  I don't know of any other test but an ekg to measure electrical activity, but the ekg can be taken under various conditions and time intervals.  A holter (ambulatory ekg) to record at different times while the indivitual performs daily activities, a stress test with ekg for measurement at rest and then with exertion, and just the ekg while inclined and at rest.

Beta blocker, etc. medication can help regulate heart rate.

For some insight, because of the LBBB, the left chamber is not contracting simultaneously with the right chamber but with a delay after contraction of the right chamber. When LBBB is present, the left chamber receives electrical impulses indirectly from the right chamber’s muscles. LBBB by itself shouldn’t cause any heart difficulties as long as the right branch is intact. But still, presence of LBBB indicates that various parts of the heart muscle are not supplied with blood very well. LBBB is, in fact, indirect proof that your husband may have had a small infarct (heart attack) in the past and that you might have a degree of coronary heart disorder (narrowing of the heart arteries).  To determine if there has been a prior infarct and echocariogram can determine if there is hypokinesis (impaired heart muscle cells) and degree of impairment.

Heart rate around 40 bpm may not be a problem, but certainly is not normal.  The 185 can be due to one's physical condition.  And the variance is unusual

[Financelady]

Thanks so much for your post, it sounds like you are very informed on the subject matter.

We have a follow up appointment with the cardiologist in two weeks. I was told by another doctor friend of ours (not a cardiologist) that there is an additional test that can be performed seperately to determine if the electrical function is working correctly. Do you happen to know anything about this test? Our friend also said that sometimes they try medication to regulate the heartbeat before going strictly to a pacemaker considering my husband's age. I just have a few more questions.

1. Can LBBB be reversed or is it something you have forever?

2. They found no blockages in his heart with the heart cath and thought the muscle was in relatively good shape: what could still be causing the LBBB? Hypertension?

3. What is considered a low heart rate to be concerned about? His resting normal rate is about 50BPM and 38-40BPM when sleeping. During excercize it gets over 185 beats per minute? The variance has me concerned.

4. Should I suggest that an ambulatory EKG machine is used for a few days to record the activity?

Thanks for all your information.

Financelady

[karinosa]

Hi Ken,

You say that "It is the soft plaque interior to the inner lining that causes the highest risk of a heart attack. "  by having the angiogram and being told that there were no blockages, is it the "soft plaque in the inner lining" that the doctor would've been looking for with the angio? or is there still a chance that I had no 'blockages' but may have this soft plaque you are talking about?   I'm not knowledgable on this at all, if you can explain it a bit more I would appreciate it.   Also what causes it to break away?

I still have unexplained high blood pressure and very fast heart rate among other things so any info you have is appreciated.

Thanks,

Karin

[kenkeith]

Quote:
"So I'm might not be able to help you but what I was told 2 days ago by my cardiologist that as long as there is no blockages there is no chance of a heart attack".

Karinosa, the typical occlusion caused by vessel plaque does not present a high risk of a heart attack at all.  It is the soft plaque interior to the inner lining that causes the highest risk of a heart attack.  The soft plaque can/will rupture the inner lining and the formation of a clot can break away and cause a heart attack.

The plaque in the lumen can reduce the blood flow to heart cells and cause chest pains.  Left untreated the reduced blood flow can damage heart cells, enlarge the heart, weaken contractions and eventually an arrhythmia or heart failure that includes pulmonary edema.
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Financelady

LBB, left bundle branch is the pathway for electrical impulses to pass and the impulse activates the heart cells to charge (during filling phase) and the discharge causes contractions.  LBBB indicates a blockage of the LBB and can interfere with normal heart rhythm by blocking the impulse.  It can be infrequent causing a skipped beat and not considered medically significant.  If serious, it can arrhythmia (very fast heart rate, very slow hr,. and or irregular heart rate).

The heart cath views the lumen of the coronary arteries, and if there is occlusion, that can diminish the flow of blood to areas deficit of a good supply.  

If there is a medical problem it would be due to the electrophysiology of the heart.  Often there is a feeling of a pounding heart (palpitations), skipped beats (often go unnoticed and not uncommon, etc).  The LBBB by itself is not cause for great concern.  Bundle Branch Block often produces no symptoms, although some people may either faint (syncope) or feel as if they're going to faint (presyncope). If both bundles are diseased, heart block may result producing syncope (fainting) or preseyncope (feeling like fainting). When this happens, the heartbeat may be so slow that an artificial pacemaker is implanted, even if the heart is otherwise healthy. Treatment may also be necessary if bundle branch block is caused by an underlying heart condition, such as damage to the heart muscle from a heart attack (myocardial infarction).

Known symptoms are :Syncope (fainting), Dizziness, Lightheadedness, Chest pain, Shortness of breath.  If the heart is not pumping sufficient blood supply due brachycardia there can be fatigue, etc.

[karinosa]

So sorry that your husband is having all this problems.  I'm no expert, but I was diagnosed with exercise induced LBBB during a stress test.  I've had 24hr holter monitor, ECG's, MIBI test, and also angiogram or heart cath and all of them are normal.  

I also have fatigue, nap during the day something I never did before, headaches, dizziness, chest pressure, fast heart rate and high blodd pressure.  The doctors can't seem to find anything wrong.  All my symptoms started after a virus, I had two bad colds back to back in September/08 and since them I have this.

As long as I lay down I feel not too bad, I'm hoping it is just a virus and that it will all go away on it's own.  They even checked me for an adrenal gland tumour but it is negative.

So I'm might not be able to help you but what I was told 2 days ago by my cardiologist that as long as there is no blockages there is no chance of a heart attack, now if the symptoms persists and they don't go away with laying down then I'm to call 911 or go to a hospital, so if they didn't see anything on your husband's tests than more than likely it is not his heart either.

As far as I was told there is no 'fix' for LBBB, LBBB is the result of underlying heart dissease, which they didn't find in my heart so I don't understand why I have it either.

Good luck and let us know how your husband is.