Bundle branch block with spontaneous remission while taking an electrocardiogram

Bundle

Branch

Block with

Remission

While

Spontaneous

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Electrocardiogram HARRY

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CANTER,

M.D.

Pmngdrwfia CASE REPORT J. B., aged forty-two, reported for a heart examination October 29, 1945. His history was

FIG. 2. Standardization 3 cm.-3 ml. Precordial leads are designated as V:! and Vs. The only change of note is a slight decrease in the potential of the T waves in the precordial lead?.

FIG. 1. Regular sinus rhythm. Rate 88. PR, 0.20, QRS, 0.12. Left axis deviation; one “premature beat in lead Vs. Left bundle branch block of thr discordand type. Left ventricular strain pattern. The three top leads are limb leads I, II and III. The precordial leads are designated a5 VP and V,.

bundle taneously graphic

branch block while having record madr.

disappeared sponan electrocardio-

not typical of an acute coronary occlusion, but he stated that for the past two months he had been treated for low blood pressure and anemia. He was a tall, well developed white male. His height was 6 feet 2 inches; weight, 279 pounds; vital capacity, 5,500 cc., 111 per cent; red blood cells, 4,200,OOO; white blood cells, 6600; hemoglobin, 12 Gm.; polymorphonuclears, 72 per cent; lymphocytes, 26 per cent; juveniles, -2 per cent. His heart was definitely enlarged on percussion. The sounds were clear and dis-

Bundle Branch Block-Cuntet

781

tinct. A faint suggestive systolic murmur was heard over thr apex and many premature heats wcrc not?cl. An IX:<; taken 0ctobr.r 30_ 1045, (Fig. 1) showed a typical picture of left bundle branch block of the discordant type. There was a left ventricular strain pattern with a prolonged PR and QRS interval. One ventricular premature beat was noted in precordial lead VS. The precordial leads were taken with the unipolar lead from a central terminal. Another ECG was taken on December 7, 1945. (Fig. 3.) This picture is essentially the same as the previous one. There is a change in the potential of the T waves in the precordial leads. Another ECG was taken on April 15, 1946. [Fig. 3.) This picture shows the first two beats in lead I to be the typical QRS complex of bundle branch block. From the third beat on the QRS complex has changed suddenly to a fairly normal appearance. The QRS complexes have lost their bundle branch appearance and look normal. There is a definite QI. The QRS complexes are all of high potential. ST1 is flattened and depressed and T1 is diphasic. Tz and Ts are now erect. A recent ECG has shown no change from this picture. DISCUSSION

Transient has

been

complete rather

Kurtz,’

Master,

reported

cases

block Kalett3

which

bundle infrequently

Dack

and

of transient later

reported

branch

block with spontaneous years.

reported. Jaffe2

bundle

became

a case

block have branch

permanent.

of bundle

remission

branch

after four REFERENCES

CONCLUSION

a case of bundle branch I have reported block which to my persona1 knowledge lasted seven months and which spontaneously returned to normal while having an ECG record made.

AMERIOAN

JOURNAI.

OF

FIG. 3. Standardization 3 cm.-3 ml. Precordial leads designated by Vs and \‘5. The first two QRS complexes in lead I are the typical bundle branch block picture. The QRS complexes III and IV show a return to a normal appearance: this appearance continues on through the balance of the tracing. The remainder of the picture is the typical pattern of left ventricular strain.

MF,D,CINE

1. KURTZ, CHESTER M. Transient. complete bundle branch block. dm. Heart 3.. 11: 212. 1936. DACK, SIMON and JAFFE, 2. MASTER, ARTHUR M., HARRY L. Bundle branch and inn-a-ventricular block in acute coronary artery occlusion. Am. Heart 3., 16: 283, 1938. 3. KALETT. JOSEPH. Bundle branch block with spontaneous remission after four years. .4m. Hmrt ,3.. 29: 112,1945.