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Case Report
 
Short left main coronary artery causing dynamic left ventricular outflow tract obstruction and new onset left bundle branch block
Geoffrey Chibuzor Nwuruku1, Godsent Chichebem Isiguzo2, Joel Tamayo Brooks3, Ernest Madu4
1MD, Registered Cardiologist and Family Physician, DOCS VIP Clinic, Enugu, Nigeria.
2MBBS, FWACP, Consultant Cardiologist, DOCS VIP Clinic, Enugu, Nigeria.
3MD, Interventional Cardiologist, Heart institute of Caribbean (HIC), Kingston, Jamaica. 4MD, FACP, FACC, FRCP Edin, Professor of Cardiology, Heart institute of Caribbean (HIC), Kingston, Jamaica, and Director, DOCS VIP Clinic Enugu, Nigeria.

doi:10.5348/ijcri-201529-CR-10490

Address correspondence to:
Dr. Godsent Chichebem Isiguzo
Cardiologist, DOCS VIP Clinic Enugu Nigeria
Consultant Physician/Cardiologist, Federal Teaching Hospital
PMB 102, Abakaliki, Ebonyi State
Nigeria
Phone: +2348035419835

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How to cite this article
Nwuruku GC, Isiguzo GC, Brooks JT, Madu E. Short left main coronary artery causing dynamic left ventricular outflow tract obstruction and new onset left bundle branch block. Int J Case Rep Images 2015;6(3):156–160.


Abstract
Introduction: Left bundle branch block can be seen in conditions like aortic stenosis, extensive coronary artery disease, primary disease of the cardiac electrical conduction system, dilated cardiomyopathy, Lyme disease; it is also associated with short left main coronary artery and dynamic left ventricular outflow tract obstruction. While the former is caused by the shearing force on septal branches of the left anterior descending artery, the latter is related to either Venturi effect in hypertrophic cardiomyopathy or effect of systolic anterior motion caused by abnormal geometric relationship of papillary muscle and the mitral apparatus.
Case Report: A 50-year-old male, former smoker with a history of dyslipidemia, presented with shortness of breath and exertional chest pain. After clinic review, he was thought to have stable angina, electrocardiogram, and echocardiography were normal and lifestyle modification was advised. Patient had some improvement, but represented seven months later with worsening of symptoms. Repeat electrocardiograph showed a new onset left bundle branch block, with short left main coronary artery on coronary angiogram and dynamic left ventricular outflow tract obstruction in stress echocardiography, with a gradient of 40 mmHg.
Conclusion: Short left main coronary artery is a rare cause of left bundle branch block, and it should be considered when evaluating patients with new onset left bundle branch block without hypertrophic cardiomyopathy.

Keywords: Erectile dysfunction, Hypertrophic cardiomyopathy, Left bundle branch block (LBBB), Left main coronary artery (LMCA), Left ventricular outflow tract (LVOT), Lyme disease, Microvascular dysfunction (MVD), Septal dyssynchrony, Short left main coronary


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Author Contributions
Geoffery Chibuzor Nwuruku – Substantial contribution to conception design, Acquisition of data, Drafting of article, Revising it critically for important intellectual content, Final approval of version to be published
Godsent Chichebem Isiguzo – Substantial contribution to conception design, Analysis and interpretation of data, Drafting of article, Revising it critically for important intellectual content, Final approval of version to be published
Joel Tamayo Isiguzo – Substantial contribution to conception design, Acquisition of data, Revising critically for important intellectual content, Final approval of version to be published
Madu Ernest – Substantial contribution to conception design, Acquisition of data, Revising it critically for important intellectual content, Final approval of version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Geoffery Chibuzor Nwuruku et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Geoffrey Chibuzor Nwuruku is Registered Cardiologist and family physician in DOCS VIP Clinic, Heart Centre, Enugu, Enugu State, Nigeria. He earned undergraduate degree, Doctor in Medicine from Latin American School of Medicine, Havana, Cuba and postgraduate degree, Specialist in Cardiology from 'Hermanos Ameijeiras' Specialist Hospital Department of Cardiology and Cardiovascular Surgery, Havana, Cuba. He has published one research paper in national academic journal. This research interests include diastolic heart failure, non dipping pattern of blood pressure and target organ damage, the relationship between clinical and echo findings in functional capacity. He intends to pursue a research fellowship with any applicable research institute of good repute in future.



Godsent Chichebem Isiguzo is Consultant Physician, Cardiologist at Medicine department, Federal teaching hospital, Abakaliki, Ebonyi state, Nigeria and Cardiologist at DOCS VIP Clinic, Heart Centre, Enugu, Enugu State, Nigeria. He earned the undergraduate degree (MBBS) from College of Medicine, Abia Stae University, Nigeria and postgraduate degree (FWACP) from West African college of Physician, following Postgraduate training at Jos University teaching hospital, Jos, Plateau state Nigeria. His fellowship thesis was on Pulmonary hypertension and HIV-related cardiac dysfunction. He has published 11 research papers in national and international academic journals. His research interests include: HIV-related heart disease, Pregnancy related heart disease, hypertension, cardiomyopathies and cardiac imaging). He intends to pursue Postdoctoral fellowship in echocardiography and Preventive cardiology in future.



Joel Tamayo Brooks is Registered Consultant Cardiologist, interventional cardiologist and family physician at the Heart Institute of the Caribbean, Kingston, Jamaica and DOCS VIP Clinic, Heart Centre, Enugu, Nigeria. He earned undergraduate degree, Doctor in Medicine from University of Medicine, Havana, Cuba and postgraduate degree, Specialist in Cardiology from 'Hermanos Ameijeiras' Specialist Hospital Department of Cardiology and Cardiovascular Surgery, Havana, Cuba. Interventional Cardiolgy fellowship, University Complex Hospital of Vigo, Spain. He has published 12 research papers in national and international academic journals and the interventional cardiologist handbook. His research interests include all the interesting topics on the interventional cardiologist field. He intends to pursue a research fellowship with any applicable research institute of good repute in future.



Ernest Madu is Professor of Cardiovascular Medicine and Imaging Technology and Chairman of the Heart Institute of the Caribbean. He has published extensively in cardiovascular medicine. His current research interests are in innovative health systems development and technology applications in emerging nations. He has given keynote lectures in many countries and is widely sought after as a global leader in innovative and disruptive healthcare applications.