Key result
Urgent revascularization successfully resolves syncope and high-grade AV block in evolving inferior MI.
Why the study?
Syncope with newly developed bradyarrhythmia or atrioventricular block may indicate acute coronary occlusion requiring early reperfusion therapy.
Case Report (n=1)
Syncope with newly developed high-grade atrioventricular block should prompt careful assessment for subtle ischemic changes in the inferior ECG leads to identify and reperfuse early occlusion myocardial infarction.
Answers are grounded in this paper and cite their sources.
May prompt ECG review for inferior ischemia in syncope with AV block; leaves open need for prospective validation.
CASE SUMMARY: A man in his early 50s with no cardiovascular risk factors presented after a brief syncopal episode and was found to have bradycardia with 2:1 atrioventricular block on electrocardiogram. Careful inspection of the inferior leads showed hyperacute T waves with subtle ST-segment elevation and reciprocal ST-segment depression, suggesting evolving inferior occlusion myocardial infarction. He underwent urgent coronary angiography, which revealed proximal right coronary artery occlusion, followed by successful percutaneous revascularization. This case highlights that syncope with new atrioventricular block may reflect acute coronary occlusion requiring early reperfusion therapy. TAKE-HOME MESSAGES: Syncope with newly developed bradyarrhythmia or atrioventricular block warrants meticulous assessment of the inferior leads for subtle ischemic changes, even when chest pain is absent. Dynamic hyperacute T waves with reciprocal inferior ST-segment changes in high-grade atrioventricular block should prompt suspicion of early inferior occlusion myocardial infarction; reperfusion is the key treatment for this symptomatic bradycardia.
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Jain et al. (2026) conducted a case report in Acute inferior myocardial infarction presenting with syncope and 2:1 atrioventricular block (n=1). Urgent coronary angiography and percutaneous revascularization was evaluated. Urgent coronary angiography and percutaneous revascularization successfully treated a man presenting with syncope and 2:1 atrioventricular block due to an evolving inferior myocardial infarction.
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