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September 1985

Intermittent Left Bundle Branch Block and Associated T-Wave Abnormalities

Author Affiliations

From the Division of Cardiology, Department of Medicine, Evanston Hospital, Evanston, Ill, and Northwestern University Medical School, Chicago.

Arch Intern Med. 1985;145(9):1667-1670. doi:10.1001/archinte.1985.00360090139021

Characteristic T-wave abnormalities transiently apparent during "normal" conduction in patients with intermittent left bundle branch block have been described1-5; the mechanism and clinical significance of these T-wave abnormalities remain uncertain. We describe a patient with intermittent left bundle branch block who demonstrated such T-wave abnormalities.

REPORT OF A CASE  A vigorous and asymptomatic 54-year-old man was refused insurance coverage because, he was told, his routine electrocardiogram (ECG) demonstrated "coronary arterial disease." He had a distant 40-pack-year history of cigarette smoking, having abstained for 20 years, and a family history of coronary artery disease in his father and paternal uncles, but he had no known history of hypertension, diabetes, or hyperlipidemia. Results of a routine physical examination and ECG two years earlier had been entirely normal.On examination, he appeared younger than his stated age, with a blood pressure of 150/90 mm Hg and a regular pulse of 70 beats