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[Sudden syncope and myocardial ischemia. Apropos of a case]
Insights
Sudden loss of consciousness (LC) can indicate heart problems. This case highlights that atrioventricular block (AVB) causing syncope may stem from underlying coronary artery disease, not just conduction issues.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Myocardial ischemia is rarely investigated in patients presenting with syncope without a prior angina history.
- Sudden loss of consciousness (syncope) can be a symptom of various underlying conditions.
Observation:
- A case of syncope was reported in a patient with sub-hissian atrioventricular block (AVB).
- Pacemaker implantation was necessary, and angina pectoris was detected immediately post-procedure.
- Coronary angiography revealed severe, multitrunk coronary artery disease with significant common trunk stenosis.
Findings:
- The patient's syncope and AVB were linked to severe coronary artery disease.
- Ischemia was identified as the cause of the atrioventricular block.
Implications:
- Clinicians should consider ischemic origins for AVB presenting as syncope, even without chest pain.
- Systematic evaluation for myocardial ischemia is crucial in unexplained syncope with conduction abnormalities.
- This case underscores the importance of a comprehensive cardiac assessment in patients with syncope and AVB.
Abstract:
It is unusual to carry out a systematic search for myocardial ischemia in patients who have suffered a sudden syncopy with no known history of angina. We report a case involving loss of consciousness (LC) in the context of sub-hissian atrioventricular block (AVB) which required the installation of a pacemaker, with the detection of angina pectoris immediately after its installation. Coronary artery angiography confirmed a diagnosis of severe, multitrunk coronary disease characterized by a tight stenosis of the common trunk. If consciousness is lost by a patient suffering from baseline conduction impairment with no chest pain, the first thought is 3rd degree degenerative paroxysmal AVB but the possibility of an ischemic origin of this AVB should not be overlooked.