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Patient
Young woman 24 years of age, with no prior history or risk factor, presenting chest pain on limited exertion; recording of a continuous electrocardiogram during moderate exercise;
Trace
In the first portion of the tracing, rhythm is sinus with a normal PR interval and a narrow QRS; upon a slight increase in heart rate, appearance of a left bundle branch block (QRS width > 120 ms, absence of q wave and wide and notched R wave in leads I, aVL, V5 and V6 with delayed intrinsicoid deflection > 60 ms, QS and rS pattern in V1 and V2, ST segment depression and negative T wave in leads I, aVL, V5 and V6);
Trace
Other tracing; upon a slight slowing of the heart rate, disappearance of the left bundle branch block pattern and return of narrow QRS complexes;
Exergue
The appearance of a left bundle branch block on exertion can cause chest pain without abnormal coronary circulation.
This young patient presented typical chest pain in the absence of prior history or risk factors. These pain episodes appeared during relatively modest exertion.