Key result
Exercise-induced transient ischemia of the infero-apical segment resulted in advanced degree AV block in a patient with critical severe right coronary disease.
Case Report (n=1)
No
Transient ischemia of the infero-apical segment during exercise stress testing can trigger a cardioinhibitory reflex leading to advanced degree AV block in patients with severe right coronary artery disease.
May signal severe right coronary disease on exercise testing; hypothesis-generating case report requiring validation.
BACKGROUND: Exercise causes enhanced sympathetic discharge and results in physiologic tachycardia. However, in some patients with a diseased conduction system resulting from acute ischemia, exercise can precipitate heart block. METHODS AND RESULTS: In this report we describe a 51 years old male patient with transient advanced degree atrioventricular (AV) block developed during recovery from exercise stress testing, resolved after the administration of atropine. Nuclear perfusion imaging demostrated stress-induced ischemia of the inferior-apical segments, and recovery of perfusion in the images obtained at rest. Coronarography showed critical stenosis of the right coronary artery, which was treated by percutaneous coronary intervention (PCI) and drug eluting stent (DES) deployment. CONCLUSION: Nuclear myocardial perfusion imaging provides noninvasive evidence that transient ischemia of the infero-apical segment can result in advanced degree AV block in patient with critical severe right coronary disease.
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Sarullo et al. (2016) conducted a case report in Exercise-induced atrio-ventricular block / Coronary artery disease (n=1). Exercise stress testing was evaluated on Development of AV block and myocardial ischemia. Exercise-induced transient ischemia of the infero-apical segment resulted in advanced degree AV block in a patient with critical severe right coronary disease.
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