Conversation: The conversation between human and AI assistant.
[|Human|] Hi I am 38 yeas old have a duel chamber pacemaker for bradycardia. Just had an EKG and was diagnosed with rbbb, I am very short of breath and tightness in my chest and have lots of tachycardia. On toprol xl just feeling terrible. Any idea if the rbbb is the culprit?
[|AI|]  Hello! Thank you for asking on Chat Doctor! I understand your concern, and would explain that facing your clinical scenario, a comprehensive differential diagnosis is necessary to be performed, to investigate the reason of shortness of breathing coupled with RBBB and chest discomfort. A careful diagnostic work up including thorough physical examination, besides resting ECG a chest X a study, a cardiac ultrasound, some lab tests such as complete blood count, CK-MB, Troponin, D-dimer, PCR, etc., are necessary to exclude acute an dangerous disorder like pulmonary embolism, a pneumonia, a heart attack, or any other form of acute chest syn Chat Doctor.  A good evaluation of cardiac performance by ECHO, investigating cardiac function, myocardial kinetics, chamber dimension quantification, any acute valve disorders, aortic or pericardial abnormalities is of utmost importance. It is helpful to rule out any possible pacemaker complications, too. RBBB is not a reason, but a sign of a possible complication. Hope to have been helpful to you. Greetings!