Q. Is chemical or nuclear echo the only relevant test to determine left bundle branch block?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 02, 2020 and last reviewed on: Feb 05, 2020

Hello doctor,

I was diagnosed with a left branch bundle block a few years back. I have been under the care of a cardiologist to make sure my heart is fine since then. I have done stress echos yearly or every two years since and have been told my heart is otherwise fine. I just had to switch the other doctor because of insurance and my new doctor says old stress echos are irrelevant, that only chemical or nuclear echos work in patients with lbbb. Is this true?

I have a strong family history of heart disease, my father survived two heart attacks, mother survived double bypass and my maternal uncle died from a heart attack, all were smokers with high cholesterol and high blood pressure. I am a former smoker. I am a 43-year-old female. I have been exercising six days per week for over 20 years. My cholesterol is high 213 but HDL is 140 and triglycerides are low. I am a little put off by a nuclear stress echo and would prefer the regular exercise. But I want to know what this new doctor says is true? Then I guess I will have to go nuclear.

I am currently taking Spironolactone 100 mg for acne, Omeprazole, and multivitamins. I just had an ultrasound of heart and EKG past monday. Doctor did not mention anything other than lbbb that was previously diagnosed.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine


Welcome to icliniq.com

Treadmill test is not very informative in case of lbbb patient, however, stress echo either exercise or nuclear is valid. Stress thallium is the best test to be done in you. I guess you did not have any symptoms like chest pain or heaviness during stress test and if so it will still suggest the absence of significant heart disease.

In my opinion, there is not much difference between exercise echo and chemical stress echo and not invalid, but nuclear scans like stress thallium is certainly a better test. I would advise for a nuclear scan as it would be more informative. Anyhow, you should have a healthy lifestyle like avoiding fatty, oily and high calorie diet. Have a low salt diet and monitor your blood pressure regularly. Do regular exercises like brisk walking, jogging according to your capacity at least 30 minutes a day and 5 days a week. Eat lots of green leafy vegetables, fruits, and fish once or twice a week. Avoid meat, smoking, and alcohol if any. There should not be any abdominal fat deposition or obesity. Get your lipid profile and sugars tested once.

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