Two Cases of Bilateral Bundle Branch Block with Prompt Transitions in One and Gradual Transitions in the Other Case
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Two cases of bilateral bundle branch block (BBBB) with atrioventricular (A-V) block were reported, and their mechanisms were discussed. Case 1, a 29-year-old unmarried police sergeant. On the day of admission, the electrocardiogram showed BBBB with 6 : 1 to 3 : 1 second degree A-V block. Transitions between LBBB and RBBB and the reverse were mostly prompt, and a QRS complex of an intermediate configuration rarely appeared. In general, the faster the atrial rate was, the severer was A-V block. The sinus rhythm was resumed on the 3rd hospital day with RBBB. The stabilized anteroseptal infarction pattern which had been present for 3 years before admission was disappeared as a result of this permanent RBBB. The Valsalva maneuver, hyperventilation and pressure on the eyeballs disclosed hypersensitivity of the autonomic nervous system, especially of the cardiac vagus. It should be emphasized that there were neither clinical symptoms nor laboratory findings of myocardial infarction, inflammation, metabolic disorders and drug intoxications. Outstanding features were that BBBB occurred after long-standing mental tension and bodily exhaustion due to daily preparation for a pass examination far into the night and frequent interruption of his short sleep by traffic accidents in the district of his jurisdiction. Case 2, a 68-year-old widow. She had been visiting the out-patient clinic, and her electrocardiogram had shown complete RBBB with regular sinus rhythm. The electrocardiogram on admission showed complete A-V block with complete LBBB and 2 : 1 A-V block with complete RBBB. The transitions between the 2 were gradual. During the transitions, there occurred a QRS complex of normal conduction, accelerated conduction, incomplete LBBB and incomplete RBBB. Also in this case, the faster the atrial rate was, the severer was A-V block. Before the normalization of A-V conduction, the PR interval was once prolonged as long as 0.46 second in 1 : 1 A-V conduction and shortened to 0.16 second in 2 : 1 A-V conduction. Occasionally, the PR interval was progressively pro-longed and then progressively shortened and vice versa. LBBB with complete A-V block disappeared on the 21st hospital day, but RBBB was left unaltered with regular sinus rhythm. Also in this case, there were neither clinical symptoms nor laboratory findings of myocardial infarction, in-flammation, metabolic disorders and drug in-toxications. It should be stressed that the patient was shocked when she saw her daughter's husband drunken throw her grandson down on the ground before the onset of BBBB with A-V block. Her daughter was a business woman, and she had to take care of her grandson. Moreover, she and her daughter's husband were always on bad terms, and her sleep was frequently interrupted by violence of her daughter's husband returning home drunken late at night.
- 社団法人日本循環器学会の論文
- 1970-10-30
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