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Published on: February 10, 2013
Exercise induced atrio-ventricular (AV) block during nuclear perfusion stress testing: a case report
Filippo Maria Sarullo1, Salvatore Accardo, Paola D'Antoni
1Department of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy. fsarullo@neomedia.it
Summary
Exercise can trigger advanced atrioventricular (AV) block in patients with severe coronary artery disease. This transient heart block, linked to exercise-induced ischemia, resolved with atropine and was treated with percutaneous coronary intervention.
Area of Science:
- Cardiology
- Electrophysiology
- Nuclear Cardiology
Background:
- Exercise normally increases sympathetic activity and heart rate.
- In patients with compromised cardiac conduction, exercise can induce heart block.
- Ischemia-related conduction system disease poses a risk during physical exertion.
Purpose of the Study:
- To report a case of transient advanced atrioventricular (AV) block during exercise stress testing recovery.
- To investigate the link between exercise-induced ischemia and heart block.
- To highlight diagnostic and therapeutic approaches for this clinical scenario.
Main Methods:
- Case report of a 51-year-old male patient.
- Exercise stress testing with electrocardiography and nuclear perfusion imaging.
- Coronary angiography, percutaneous coronary intervention (PCI), and drug-eluting stent (DES) deployment.
Main Results:
- Transient advanced degree AV block occurred during recovery from exercise stress testing.
- Nuclear imaging revealed stress-induced inferior-apical ischemia with rest recovery.
- Coronary angiography showed critical right coronary artery stenosis, successfully treated with PCI and DES.
Conclusions:
- Nuclear myocardial perfusion imaging can noninvasively identify transient ischemia.
- Infero-apical ischemia can precipitate advanced AV block in severe coronary artery disease.
- This case underscores the importance of evaluating ischemia in exercise-induced heart block.
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