{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:23:18Z","timestamp":1763684598838,"version":"3.40.4"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,10,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The presence of a left bundle-branch block (LBBB) among firefighters raises questions about stratifying risk of subsequent cardiovascular events as this conduction disorder may mask underlying coronary artery disease. This report describes the case of a firefighter with a history LBBB with exertional dyspnoea of recent onset after work activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>A 39-year-old male firefighter with LBBB developed exertional dyspnoea after a prolonged session of work. ECG and treadmill test only showed a permanent LBBB; echocardiography and myocardial scintigraphy did not add to this. However, multislice CT (MSCT) showed a significant stenosis in the mid-left anterior descending artery (LAD). Coronary angiography confirmed the stenosis with subsequent placement of a coronary stent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An occupational physician should take into account that factors such as age and low cardiovascular risk do not always exclude heart disease, especially when there are conduction system abnormalities that can mask possible coronary artery disease.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bcr-2014-207424","type":"journal-article","created":{"date-parts":[[2014,10,28]],"date-time":"2014-10-28T11:38:14Z","timestamp":1414496294000},"page":"bcr2014207424","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Onset of recent exertional dyspnoea in a firefighter with left bundle-branch block"],"prefix":"10.1136","volume":"2014","author":[{"given":"Roberto","family":"De Rosa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gennaro","family":"Ratti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Lamberti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,10,28]]},"reference":[{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.1","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1056\/NEJMoa060357","article-title":"Emergency duties and deaths from heart disease among firefighters in the United States","volume":"26","author":"Kales","year":"2007","journal-title":"N Engl J Med"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.amjcard.2007.10.017","article-title":"Predictors of on-duty coronary events in male firefighters in the United States","volume":"26","author":"Geibe","year":"2008","journal-title":"Am J Cardiol"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.3","doi-asserted-by":"crossref","first-page":"301","DOI":"10.5491\/SHAW.2011.2.4.301","article-title":"Exploring occupational and behavioral risk factors for obesity in firefighters: a theoretical framework and study design","volume":"26","author":"Choi","year":"2011","journal-title":"Saf Health Work"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/ajh.2008.296","article-title":"Blood pressure in firefighters, police officers, and other emergency responders","volume":"26","author":"Kales","year":"2009","journal-title":"Am J Hypertens"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1097\/CRD.0b013e318215c105","article-title":"Cardiovascular disease in US firefighters: a systematic review","volume":"26","author":"Soteriades","year":"2011","journal-title":"Cardiol Rev"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.6","first-page":"387","article-title":"Rhythm and conduction disorders in formulating a judgment of work fitness","volume":"89","author":"Picciotto","year":"1998","journal-title":"Med Lav Medicina del Lavoro"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.7","first-page":"44","article-title":"firefighter fatalities due to sudden cardiac death, 1995\u20132004","volume":"99","author":"Fahy","year":"2005","journal-title":"Nat Fire Pro Assoc J"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060357"},{"key":"2025042706493822000_2014.oct28_1.bcr2014207424.9","unstructured":"Karter MJ , Molis JL . 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