### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
In October 2013 I had a syncope episode. Went to GP who did an ECG and found I have a left bundle branch block. Went to ED where MI and PE were excluded.Referred to cardiologist .Had holster monitoring, stress test, Ecco cardio gram. Found to be fit on stress test. Holster monitor confirmed arrhythmia sand LBB. Eccocardiogram did not anything unusual ( so I was told). Have been told to go back in 6 months . My general health is good. I was drinking 2 to 3 standard drinks 4 nights a week. Have now ceased alcohol altogether. I m within a healthy BMI range and I exercise regularly. Family history - brother had an MI at aged 30 due to a blocked artery. Ok now. Family history of diabetes type 2 and I had gestational diabetes with first baby at age 40. I don t feel satisfied with information I have been given. Not sure what further questions to ask or whether I should ask for further investigations. Can you comment?

### output:

Hello Madam, I understand your concern. You have so far received standard tests for screening heart disorders. The LBBB has to be treated, since you have significant risk factors for heart disease in your case.-Family history of MI in brother.-Family history of type 2 DM.-H/o Gestational diabetes. This can make you prone to early onset DM. Patients with LBBB require complete cardiac evaluation, and those with LBBB and syncope or near-syncope may require a pacemaker. Probable causes of LBBB in your case are either an occluded coronary artery or intrinsic disease of the conduction system. Since Holder ECG is normal, primary conduction disorders can be reasonably ruled out. To screen for blocking coronaries, I strongly recommend Coronary angiogram-CAG and highlight the need for temporary or permanent pacemaker implantation. Check with your cardiologist if he shares a similar opinion. Post your further queries if any, Thank you.