Does a normal stress test rule out coronary artery blockages, if RBBB and chest pain are present?

Submitted by Brian from Stratford Ontario, Canada on 07/09/2014

by James T. Willerson, MD

The type of chest pain is important. If it is a tightness in the chest with effort or emotion relieved by rest, it is of concern for coronary heart disease. Right bundle branch block is found in some normal individuals, as well as in patients with atrial septal defects [hole between the 2 upper chambers of the heart], and some patients with electrical conduction abnormalities. It is not generally associated with coronary heart disease. A well done and correctly interpreted nuclear stress test should have 90 percent accuracy in ruling out significant coronary heart disease or “blocked arteries ” in the heart. However, a normal nuclear stress test does not absolutely rule out a blocked artery. You need to see an experienced cardiologist to help evaluate these issues. Thank you.