This patient does not have LBBB!!
Septal ischemia without involvement of other portions of LAD territory is uncommon.
Coronary Angiography:
LAD - 80% proximal stenosis.
1st marginal branch - 40% stenosis.
Left ventricular angiography reveals normal left ventricular function.
Comment:
Since this patient was heavily beta-blocked, the achieved heart rate was quite low in spite of an impressive performance on the treadmill.
It is generally recommended to reduce or stop beta-blocker agents before diagnostic testing for ischemia. If reduction / stop of beta-blocker is not possible, pharmacologic vasodilatation often works better.
