Casos

Young man, approximately 40 years old with evolutionary RBBB that disappears

Dr. Paul Levine (RIP)
Dr. Paul Levine (RIP)
USA

Case presentation

I would greatly appreciate your counsel (and that of the other members of the arrhythmia/ECG distribution) with respect to the attached series of ECGs. In 2008, this young man (approx. 40 years old) had an incomplete RBBB. In 2009, he had a complete RBBB with a leftward axis. In 2010, the bundle branch block has resolved. The rates are never that fast to invoke a rate-dependent RBBB. His BP is normal, his physical exam is normal. He exercises on a regular basis. He is of small stature and thin. His ECG from 2010 is accompanied by his blood chemistry tests as well as a report of his chest x-ray and pulmonary function tests. He does not smoke.
My recommendation was to do nothing special but to just follow this on an annual basis unless symptoms (syncope, presyncope, dyspnea, etc) develop but I have not seen this pattern of initial worsening of an intraventricular conduction abnormality followed by a near normalization of the 12 lead ECG.


Apresentaçao do caso

Em 2008 este jovem homem de aproximadamente 40anos tinha um padrão de BIRD. Em 2009 ele apresentava CRBBB com desvio do eixo para esquerda. Em 2010 o bloqueio de ramo desapareceu. As FC nunca foram elevadas o BRD taquicárdico-dependente.

Sua Pressão arterial é normal. Seu ECG desde 2010 estas sendo acompanhado com exames de sangue periódicos e Rx de tórax e função pulmonar. Ele não fuma.

Minha recomendação foi nada em especial mais apenas acompanhamento anual em relação a sintomas como sincope , presincope e dispnéia etc. Ele faz exercícios regularmente. Mas eu não tenho visto este padrão inicial de piora de um distúrbio domótropo intraventricular seguido de uma quase normalização tardia em seu ECG de 12 derivações

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