Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of newly identified or chronic Left Bundle Branch Block (LBBB) on ECG. Patient reports [asymptomatic/palpitations/syncope/presyncope/dyspnea on exertion]. No history of acute chest pain or diaphoresis. Review of systems negative for orthopnea or paroxysmal nocturnal dyspnea.
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, 2+ bilaterally. No peripheral edema. Lungs clear to auscultation bilaterally. No jugular venous distention.
Treatment Protocol
Plan: 1. Obtain baseline transthoracic echocardiogram (TTE) to assess for structural heart disease and left ventricular ejection fraction (LVEF). 2. Consider Holter/event monitoring if symptomatic. 3. Evaluate for underlying coronary artery disease via stress testing or coronary angiography if clinically indicated. 4. Optimize management of hypertension and heart failure if present.