Exercise Induced Atrioventricular Block in a Patient With Aortic Stenosis

Richard Good, Andrew R Chapman, Jamie AL Smith, Stephen J Leslie

Abstract


     We present the case of a 62 years old gentleman with recurrent presyncopal episodes. During his first admission, an initial ECG revealed right bundle branch block and echocardiogram revealed moderate aortic stenosis, but no further precipitants were identified. A further episode prompted his readmission, and the patient requested to demonstrate symptoms whilst exercising. During exercise no symptoms were noted, but after a short period of rest, his symptoms appeared. ECG testing revealed second degree atrioventricular block (Mobitz type II), and a prolonged ventricular pause of almost six seconds. It is known that calcific aortic stenosis is associated with impaired atrioventricular node conduction, particularly when there is annular calcification. Whilst exercise testing is generally discouraged in symptomatic aortic stenosis, this case serves as a reminder that potentially treatable conduction disorders can be easily missed. Atrioventricular block should be considered when patients with aortic stenosis present with isolated presyncope. To our knowledge, this is the first case report to describe exercise induced transient AV node block in the presence of moderate to severe aortic stenosis.




doi:10.4021/jmc464w 


Keywords


Aortic stenosis; Syncope; Atrioventricular block; Pacemaker; Exercise test

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