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Forum Name: Cardiology Diagnostics

Question: Heart murmer/incomplete right bundle branch block


 shotofclarity - Sun Sep 20, 2009 11:42 pm

I am a 22 year old female, with lupus. I've had sharp chest pain that lasts for only a few seconds at a time but had a chest X-ray 1 year ago and they said everything is normal. The past few weeks I've been feeling like my heart is suddenly pumping so hard through my chest. It is happening much more frequently now, a few times every day. I was told last week I had a heart murmur and an EKG that showed I have an incomplete right bundle branch block. I am getting bloodwork taken tomorrow to check for anemia (I have a history of it, but 6 months ago I was fine). I am so scared that one of these episodes with my heart I will have a heart attack or go into cardiac arrest. What is the chance of that happening? And are the murmur and BBB related?
 John Kenyon, CNA - Wed Oct 21, 2009 9:10 pm

User avatar Hello -- From the sound of your symptoms you do not have any life-threatening problems. While I cannot, of course, prove this in cyberspace, I can tell you what you describe is all generally very common in the healthy population and each issue separately is almost always benign. You could possible have something called mitral valve prolapse (MVP), which is in itself almost always benign and is so common it is often called a "variant of normal." However it can cause an increase in the frequency of palpitations (also very common and normal in the healthy population) and is sometimes accompanied by a click murmur. Finding of a murmur with no explanation is one of the greatest errors made my physicians, and can be infuriating because most such murmurs are totally innocent and meaningless. However, since it was noted it needs to be explained or followed up with a cardiological workup, which would serve as a reassurance to you while ruling out any possible obscure structural problem. MVP is often associated with a "click" murmur which is peculiar to the syndrome. It is harmless. RBBB is also harmless and almost never diagnostic of anything. It occurs in many normal hearts. It can make a funny-looking EKG tracing, but that's about it. The palpitations you've been having are common and generally are meaningless, but can be very upsetting if not explained properly. It would seem your doctor missed every chance to reassure you, which is disturbing to say the least. A meaningless murmur, palpitations, and a meaningless RBBB noted -- and incomplete at that -- area all findings that, if mentioned at all, should be explained as almost always totally benign. I would, at most suggest you request both an explanation of these findings and perhaps an echocardiogram to rule out -- or in -- MVP, which would only serve, if MVP is present, to reassure you that there's something but it's harmless. If it's not present and nothing else is found (which is the most likely outcome) then you would still feel reassurance. Either way the odds are there's nothing significant going on at all, and certainly no suggestion of anything that would result in cardiac arrest, although with the ham-handed way your doctor delivered his findings you are definitely entitled to a clarification and perhaps that echocardiogram, and I would insist on both. Meanwhile I think you can safely relax and, if the palpitations become truly disturbing or annoying there are medications that can reduce their frequency, but it's best if this can be avoided. In short, everything sounds well within normal limits, with a possible benign condition that rarely requires any treatment at all.

Hope this helps. Good luck to you and please do follow up with us here as needed.

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