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Progressive atrioventricular block during exercise in univentricular heart.
Pacing and Clinical Electrophysiology : PACE
|November 1, 1986
Summary
Univentricular heart patients experiencing exertion-induced nausea may have atrioventricular block. Pacemaker implantation relieved symptoms, highlighting the importance of exercise testing for at-risk individuals.
Area of Science:
- Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Univentricular heart physiology presents unique challenges in cardiovascular management.
- Atrioventricular (AV) block is a potential complication that can affect cardiac function.
- Exertion can unmask underlying cardiac electrical abnormalities.
Observation:
- Two patients with univentricular hearts reported recurrent nausea and vomiting during physical exertion.
- Resting electrocardiogram showed normal 1:1 atrioventricular conduction.
- Exercise stress testing revealed progressive, high-grade, second-degree AV block coinciding with symptom onset.
Findings:
- High-grade atrioventricular block can be induced by exertion in patients with univentricular hearts.
- Nausea and vomiting during exertion may be an atypical presentation of exercise-induced AV block.
- Permanent pacemaker implantation effectively resolved the exertional symptoms.
Implications:
- Exercise testing is crucial for diagnosing exertional AV block in at-risk populations.
- Clinicians should consider AV block in patients with univentricular hearts presenting with unexplained exertional symptoms like nausea.
- Early diagnosis and intervention, such as pacemaker implantation, can significantly improve quality of life.