Clinical and Angiographic Correlation of Chest Pain with Right Bundle Branch Block

Background and Objectives: Prognostic value of incidentally discovered RBBB has important implications for cardiovascular risk assessment. This research intended to describe the prevalence and severity of CAD in patients presenting with chest pain and RBBB by correlating clinical and angiographic findings. Methodology: This one cross-sectional study was conducted in the Department of Cardiology of a tertiary care centre in North Karnataka from January 2012 to December 2012. A total of 50 patients presenting with chest pain and RBBB (both complete and incomplete) on ECG were included. The patients underwent chest X-ray, ECG and 2D echocardiography. Coronary angiography was done in the eligible patients and the findings with regard to LAD, ramus, LCX, OM and RCA were noted. Results: Majority of the patients were males (88%) and the commonest age group was more than 60 years (48%). History of hypertension, diabetes and hyperlipidemia were noted in 56%, 36% and 26% respectively. Personal history of smoking was reported by 52% while tobacco chewing and alcohol consumption was reported by 22% and 30%. Myocardial infarction was noted 48% of the patients and anterior wall MI was present in 62.5%. Abnormal coronary angiographic findings were noted in 82% and 48% of the patients had multivessel disease with involvement of proximal LAD (54%). Statistically significant association was found between coronary artery disease and male sex, age more than 60 years, comorbid conditions, habits, hypertriglyceridemia, low HDL, troponin I. Conclusion and interpretation: There is high rate of CAD in patients presenting with chest pain and RBBB. Angiography may be recommended among these patients to rule out the presence of CAD so as to advocate the effective management strategy.