Transient left bundle branch block associated with very high coronary artery calcium: a case report
Coronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC i...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-09-01
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| Series: | Therapeutic Advances in Cardiovascular Disease |
| Online Access: | https://doi.org/10.1177/17539447231196758 |
| _version_ | 1797680786214748160 |
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| author | Alexander C. Razavi Sindhu Prabakaran Mariem Sawan Lakshmi Tummala Ifeoma Onuorah Sagar B. Amin Marly van Assen Carlo N. De Cecco Arshed A. Quyyumi Seamus P. Whelton Laurence S. Sperling Francois G. Rollin |
| author_facet | Alexander C. Razavi Sindhu Prabakaran Mariem Sawan Lakshmi Tummala Ifeoma Onuorah Sagar B. Amin Marly van Assen Carlo N. De Cecco Arshed A. Quyyumi Seamus P. Whelton Laurence S. Sperling Francois G. Rollin |
| author_sort | Alexander C. Razavi |
| collection | DOAJ |
| description | Coronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC in a 64-year-old woman with hypertension, type 2 diabetes, and hyperlipidemia presenting with dyspnea. Initial electrocardiogram (ECG) demonstrated normal conduction with a heart rate of 76 beats/min, but new T-wave inversions in V1–V4 and a high-sensitivity troponin-I (hsTnI) value of 6 ng/L (normal < 6 ng/L). Repeat ECG in the emergency department showed normal sinus rhythm (heart rate of 80 beats/min); however, it subsequently demonstrated a left bundle branch block (LBBB) with a repeat hsTnI of 7 ng/L. Stress testing with pharmacologic single-photon emission computerized tomography did not show scintigraphic evidence of ischemia but noted extensive CAC and a concern for balanced ischemia. Subsequent coronary computed tomography angiography (CCTA) showed nonobstructive disease and a total Agatston CAC score of 1262. Invasive evaluation with left heart catheterization was deferred given the patient’s unchanged symptoms and CCTA findings. Statin therapy was intensified and aspirin, metoprolol succinate, and antihypertension therapies were continued. Initiation of glucose-lowering therapy and lipoprotein(a) testing was strongly recommended on follow-up. Our case suggests that CAC ⩾ 1000 may be incidentally associated with transient LBBB during the workup of coronary artery disease. Here, we specifically show that functional testing that incorporates measurement of CAC burden can help to improve ASCVD-preventive pharmacotherapy initiation and intensification beyond the identification of obstructive disease alone. |
| first_indexed | 2024-03-11T23:35:20Z |
| format | Article |
| id | doaj.art-cb2a9fbd5c26488caac2fd64ff9423f4 |
| institution | Directory Open Access Journal |
| issn | 1753-9455 |
| language | English |
| last_indexed | 2024-03-11T23:35:20Z |
| publishDate | 2023-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Cardiovascular Disease |
| spelling | doaj.art-cb2a9fbd5c26488caac2fd64ff9423f42023-09-20T05:03:45ZengSAGE PublishingTherapeutic Advances in Cardiovascular Disease1753-94552023-09-011710.1177/17539447231196758Transient left bundle branch block associated with very high coronary artery calcium: a case reportAlexander C. RazaviSindhu PrabakaranMariem SawanLakshmi TummalaIfeoma OnuorahSagar B. AminMarly van AssenCarlo N. De CeccoArshed A. QuyyumiSeamus P. WheltonLaurence S. SperlingFrancois G. RollinCoronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC in a 64-year-old woman with hypertension, type 2 diabetes, and hyperlipidemia presenting with dyspnea. Initial electrocardiogram (ECG) demonstrated normal conduction with a heart rate of 76 beats/min, but new T-wave inversions in V1–V4 and a high-sensitivity troponin-I (hsTnI) value of 6 ng/L (normal < 6 ng/L). Repeat ECG in the emergency department showed normal sinus rhythm (heart rate of 80 beats/min); however, it subsequently demonstrated a left bundle branch block (LBBB) with a repeat hsTnI of 7 ng/L. Stress testing with pharmacologic single-photon emission computerized tomography did not show scintigraphic evidence of ischemia but noted extensive CAC and a concern for balanced ischemia. Subsequent coronary computed tomography angiography (CCTA) showed nonobstructive disease and a total Agatston CAC score of 1262. Invasive evaluation with left heart catheterization was deferred given the patient’s unchanged symptoms and CCTA findings. Statin therapy was intensified and aspirin, metoprolol succinate, and antihypertension therapies were continued. Initiation of glucose-lowering therapy and lipoprotein(a) testing was strongly recommended on follow-up. Our case suggests that CAC ⩾ 1000 may be incidentally associated with transient LBBB during the workup of coronary artery disease. Here, we specifically show that functional testing that incorporates measurement of CAC burden can help to improve ASCVD-preventive pharmacotherapy initiation and intensification beyond the identification of obstructive disease alone.https://doi.org/10.1177/17539447231196758 |
| spellingShingle | Alexander C. Razavi Sindhu Prabakaran Mariem Sawan Lakshmi Tummala Ifeoma Onuorah Sagar B. Amin Marly van Assen Carlo N. De Cecco Arshed A. Quyyumi Seamus P. Whelton Laurence S. Sperling Francois G. Rollin Transient left bundle branch block associated with very high coronary artery calcium: a case report Therapeutic Advances in Cardiovascular Disease |
| title | Transient left bundle branch block associated with very high coronary artery calcium: a case report |
| title_full | Transient left bundle branch block associated with very high coronary artery calcium: a case report |
| title_fullStr | Transient left bundle branch block associated with very high coronary artery calcium: a case report |
| title_full_unstemmed | Transient left bundle branch block associated with very high coronary artery calcium: a case report |
| title_short | Transient left bundle branch block associated with very high coronary artery calcium: a case report |
| title_sort | transient left bundle branch block associated with very high coronary artery calcium a case report |
| url | https://doi.org/10.1177/17539447231196758 |
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