Coronary artery disease and Left Branch Bundle Block

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Submitted by Dr T on December 5, 2012 – 9:34am

Question: 
Your question:I had a stent put in about 7 years ago now. I recently had a stress test and it was stopped because they said I had a left branch bundle block. Is there a relationship to the blocked arteries that were not proven to need stents a few years ago? is this saying that they are all now blocked and I need more stents? I have no pain and no way to tell that I have the left branch bundle block. What is the treatment or is there one? 

Answer:
The presence of a new left branch bundle block (LBBB) may be associated with progressive coronary artery disease (CAD) and if so, it would increase your risk for a heart attack. If the only finding is a LBBB, w/o other evidence of insufficient blood supply to your heart (called ischemia), an alternative next step to prove more CAD is a CTCA.  The results could indeed prove you have CAD, but since you are asymptomatic (no angina), that doesn’t automatically mean you need a stent or bypass surgery unless you have developed so-called Left main disease.
In asymptomatic patients with heart disease, medical treatment is often superior to stenting (the treatment doctors might recommend if they find CAD).
Hope this helps,
Dr T

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