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Exercise-related atrioventricular block. Influence of myocardial ischemia
N L Coplan1, M C Morales, P Romanello
1Department of Medicine, Lenox Hill Hospital, New York.
Insights
Exercise stress tests can reveal exercise-related heart block, potentially caused by myocardial ischemia. Successful angioplasty resolved the heart block and ischemia in a 62-year-old woman.
Area of Science:
- Cardiology
- Electrophysiology
- Ischemic Heart Disease
Background:
- Exercise stress testing is a common diagnostic tool for evaluating coronary artery disease.
- Heart block, a condition affecting the heart's electrical signaling, can manifest during or after physical exertion.
Observation:
- A 62-year-old woman developed complete heart block immediately after an exercise stress test.
- Coronary arteriography identified a significant blockage in her right coronary artery.
Findings:
- Percutaneous coronary intervention (angioplasty) successfully treated the coronary artery lesion.
- Post-angioplasty Thallium-exercise testing showed no inducible ischemia.
- No arrhythmias were observed after the intervention, indicating resolution of the heart block.
Implications:
- This case suggests that exercise-induced complete heart block can be a manifestation of underlying myocardial ischemia.
- Identifying and treating coronary artery lesions may resolve exercise-related arrhythmias.
- Further research into the link between ischemia and cardiac conduction abnormalities is warranted.
Abstract:
A 62-year-old woman was noted to have complete heart block immediately following an exercise stress test. Coronary arteriography subsequently revealed a significant lesion in the right coronary artery, which was successfully dilated. Thallium-exercise testing following angioplasty showed no evidence of inducible ischemia and no arrhythmia was seen, supporting the idea that exercise-related heart block may occur secondary to myocardial ischemia.