A patient in their early 60s presented to the cardiology clinic with a 2-week history of chest pain during exertion. The chest pain consistently presented during physical activity, with characteristics indicative of typical angina. The patient was a nonsmoker with no family history of premature coronary artery disease. The baseline 12-lead electrocardiogram (ECG) showed no substantial abnormalities.
A stress ECG was performed during a treadmill test using the Bruce protocol. The patient developed a left bundle-branch block (LBBB) in stage 2 at a heart rate of 107 beats per minute and experienced chest pain, identical to the previous anginal pain (Figure, A). The treadmill test was immediately terminated, with LBBB resolution following exercise cessation and angina relief occurring seconds later (Figure, B).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Yun-Tao Zhao, MD, PhD, Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Rd, Haidian District, Beijing 100049, China (email@example.com).
Published Online: August 28, 2023. doi:10.1001/jamainternmed.2023.2264
Conflict of Interest Disclosures: None reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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