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ACS with New LBBB — EECC MCQ

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ModerateCoronary Artery DiseaseACS with New LBBBEECC

A 59-year-old man presents with a 2-hour history of central chest pain. His ECG shows new left bundle branch block that was not present on a previous ECG. High-sensitivity troponin T at presentation is 22 ng/L (URL 14 ng/L). He is haemodynamically stable. Blood pressure is 138/82 mmHg. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Apply the 0h/1h troponin algorithm and manage as suspected NSTE-ACS

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

Per the 2023 ESC ACS Guidelines, new LBBB alone is no longer automatically treated as a STEMI-equivalent. Patients with suspected ACS and new LBBB should be managed based on clinical context and the hs-cTn algorithm. An immediate invasive strategy should be considered if there are very high-risk features, but in a stable patient, the 0h/1h troponin pathway should be applied. Automatic STEMI-equivalent treatment (A) is no longer recommended. Fibrinolysis (C) is inappropriate without confirmed STEMI. Outpatient follow-up (D) is too delayed. CTCA (E) is not the appropriate acute investigation.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes