Brief Answer:
I would explain as follows:

Detailed Answer:
Hello,

Welcome back on HCM!

I understand your concern and would like to explain that LAFB (left anterior fascicular block) is seen in a minority of patients with acute myocardial infarction (mainly anterior, less inferior myocardial infarction), but also in other pathologies like hypertrophied myocardium (hypertension), degenerative processes of cardiac conduction system, calcified aortic valve disease, etc.

Regarding the concomitant bundle branch block which in fact sounds logically to be right bundle branch block (RBBB), it may be seen in cardiac disorders (ischemic, degenerative, several cardiomyopathies, congenital heart disorders, etc.) as well as pulmonary diseases (pulmonary arterial disorders, etc.), as well as in clinically normal individuals.

So, all the above explanations mean you may have a bifascicular block, which needs to be periodically monitored. But as you have resulted clinically normal, you shouldn’t worry too much about it.

If these actual findings progress to a more advanced disorder (ex.: the addition of first degree atrio-ventricular block, etc.), then the alternative of a pacemaker implantation could be an option.

For the moment, just relax!

I would like to possibly directly review your ECG, if you could upload it here.

Besides your anti-lipemiant therapy which should be continued together with preventive measures like healthy diet (poor in saturated fats), a physically active daily lifestyle, I recommend you always considering possible other coronary risk factors like hypertension occurrence, avoiding close smoking contacts, glucose metabolism disorders, etc..

As your doctors (GP and cardiologist) have concluded that you are clinically normal, means that you have resulted normal during physical examination and cardiac ultrasound.

Coming to this point, I recommend you to discuss with your doctor to possibly perform a cardiac stress test, which could help to discriminate a silent ischemic cardiac disease.

I would be glad to review any possible medical tests.

Hope to have been helpful!

Wishing a Happy New Year!

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion as follows:

Detailed Answer:
Hi again!

A silent cardiac ischemia means that we don't have to do with a traditional chest pain or shortness of breath due to myocardial ischemia, but just with atypical presentation such as asymptomatic ischemic ECG changes (such as ST segment depression), which or just any arrhythmia (such as atrial fibrillation), etc., or even any cardiac conductance abnormality such as atrio-ventricular block, bundle branch block or less frequently vascicular block.

A cardiac stress test would be helpful in discriminating a silent myocardial ischemia.

But as you have already performed a cardiac stress test, which has resulted normal, the above suppositions remain only suppositions. No further tests are actually necessary.

Regarding pacemaker implantation, as I explained you above, with your actual intraventricular blocks, it is not necessary and would not be helpful at any point.

Only if any severe conductance disturbances would appear in the future, pacemaker implantation would be a matter to consider.

For the moment just relax, because you look clinically normal and nothing else is needed.

Hope to have been helpful!

If you have any other uncertainties you can ask me directly at any time at the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Greetings!

Dr. Iliri

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Brief Answer:
You are right!

Detailed Answer:

Hi,

For sure, if something abnormal could have resulted on that cardiac stress test, further diagnostic workup and a therapy would have been recommended as a consequence.

You can rate my answer if your uncertainties seem to be clarified.

Regards,

Dr. Iliri

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