Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of Left Bundle Branch Block (LBBB) identified on recent ECG. Patient reports [asymptomatic / palpitations / exertional dyspnea / syncope / chest discomfort]. No history of acute coronary syndrome, heart failure, or structural heart disease. Review of systems negative for orthopnea, PND, or peripheral edema.
Clinical Examination Findings
Cardiovascular exam: Regular rate and rhythm. S1 and S2 present. Paradoxical splitting of S2 may be noted. No murmurs, rubs, or gallops. Peripheral pulses symmetric and full. No jugular venous distention or peripheral edema. Lungs clear to auscultation bilaterally.
Treatment Protocol
Management plan: 1. Baseline 12-lead ECG to confirm QRS duration >120ms and morphology. 2. Transthoracic echocardiogram to assess left ventricular function and wall motion abnormalities. 3. Consider stress testing or cardiac MRI if ischemia is suspected. 4. Monitor for progression to high-grade AV block. 5. Optimize management of underlying comorbidities (HTN, CAD).