chronic LBBB and stress test - r111010

[ArchivalUser]

hi, everyone...fisher says in one of his video, that for you to do a stress test you have to be able to do exercise and the EKG have to be able to be reading by you so if the pt has any condition that the EEG has base line problem you can not do a stress test, like LBBB,pt on digoxin and BB because if you find any problem you wont know if the pt have the problem because the exercise or the base line problem... the B is the only one without stress test...

[ArchivalUser]

@anthrax
Yes we csnnot use ECG if patient has LV hypertrophy, previous MI, on digoxin or has LBBB.
Having LBBB precludes use of ECG but the question is whether LBBB precludes use of exercise?

[ArchivalUser]

Archer cardiology lecture says you just can't do anything with a tachycardic stress in patients with LBBB and pacemakers. There is a high rate of false positives in those patients . Among patients who undergo exercise nuclear imaging, LBBB is associated with transient positive defects in the anteroseptal and septal regions in the absence of any lesion within the left anterior descending coronary artery in approximately 10 to 20 percent of cases. So, Archer says to use Vasodilator stress in these patients.
I referred medscape also and this is correct.

see this question also from Archer q bank

Q99) A 65 y/o man with presents to your office with complaints of exertional chest pain for the past 4 weeks. The chest pain is usually left sided, occurs on walking about three blocks and goes away with rest. He has developed a habit of taking rest when the chest pain comes and he did not think it needed medical attention until his friend told him yesterday that it might be a symptom of heart disease. He is concerned and requests your recommendation. He denies any chest pain now. He also reports no change in quality or intensity of his chest pain. His past medical history is significant for pacemaker insertion for a symptomatic second degree heart block, Hypertension, and Smoking . His medications include lisinopril, atenolol and hydrochlorthiazide. Physical examination is benign. An EKG is obtained which reveals pacemaker rhythm with secondary ST-T changes. The next best step in establishing the diagnosis in this patient is :
A) 2 D -Echocadiogram
B) Exercise Stress Test ( Treadmill Stress Test)
C) Dobutamine Stress Echocardiogram
D) Persantin Stress Test
E) Cardiac Catheterization

[ArchivalUser]

check slide number 21 and listen to that lecture http://www.slideshare.net/usmlegalaxy/ca...mle-step-3

[ArchivalUser]

@fighter4life ....Thanks.

[ArchivalUser]

B is the right answer, with LBBB you can't do exercise and you need to do adenosine

[ArchivalUser]

stress echo is superior to nuclear imaging , though very less facilities do that , mksap 16 favors c