title: Masquerading Bundle Branch Block: A Poor Prognostic Sign Revisited.
abstract: Masquerading bundle branch block is a rare but important finding on the Electrocardiogram (ECG). It is an indication of severe and diffuse conduction system disease and usually indicates poor prognosis. The precordial leads show a Right Bundle Branch Block (RBBB) pattern while the limb leads resemble a Left Bundle Branch Block (LBBB). This finding on an ECG is almost invariably associated with severe underlying heart disease. It is extremely important to be aware of this finding as it is a marker of poor cardiac outcomes. We report the case of a 68-year-old gentleman, who presented with progressive dyspnoea on exertion over three months. ECG showed a broad QRS complex with a RBBB pattern on the precordial leads and a LBBB pattern on the limb leads (suggestive of masquerading bundle branch block). A coronary angiogram revealed severe Triple Vessel Disease (TVD). The patient was scheduled for an early Coronary Artery By-Pass Grafting Surgery. However, his clinical condition deteriorated and he died while awaiting the surgery.
authors: Registrar, Department of Cardiology, KMC Manipal, Manipal University , Manipal, Karnataka, India .
authors: Suheil
authors: S
authors: Dhanse
authors: Associate Professor, Department of Cardiology, KMC Manipal, Manipal University , Manipal, Karnataka, India .
authors: Hashir
authors: H
authors: Kareem
authors: Professor, Department of Medicine, KMC Manipal, Manipal University , Manipal, Karnataka, India .
authors: Tom
authors: T
authors: Devasia
authors: Registrar, Department of Cardiology, KMC Manipal, Manipal University , Manipal, Karnataka, India .
authors: Mugula Sudhakar
authors: MS
authors: Rao
keywords: Congestive heart failure; Left anterior hemi fascicular block; Triple vessel disease