A Rare Case of Complete Heart Block in a Young Patient

Area of Science:

• Cardiology
• Nephrology
• Hypertension Research

Background:

• Complete heart block (CHB) is a dangerous cardiac arrhythmia that can lead to fatal arrhythmias.
• CHB can be congenital or acquired, with symptoms ranging from asymptomatic to palpitations, presyncope, dyspnea, or chest pain.
• Excluding secondary causes like infections, ischemia, myopathies, autoimmune, or endocrinological diseases is crucial in CHB work-up.

Observation:

• A 31-year-old male presented with incidental findings of hypertension, bradycardia, and CHB.
• Work-up revealed left ventricular hypokinesia, low ejection fraction, concentric hypertrophy, an abdominal aortic thrombus with bilateral renal artery stenosis, and signs of chronic arterial changes.
• The patient had uncontrolled hypertension secondary to bilateral renal artery stenosis.

Findings:

• The patient underwent bilateral renal artery stenting and permanent pacemaker insertion.
• Post-intervention, blood pressure was controlled with a single medication.
• Subsequent CT angiogram confirmed no residual renal artery stenosis.

Implications:

• Uncontrolled hypertension can cause hypertensive cardiomyopathy, leading to conduction abnormalities like CHB.
• While hypertension may have treatable underlying causes, a permanent pacemaker is essential for managing CHB.
• This case highlights the importance of investigating secondary causes of hypertension, such as renal artery stenosis, in young patients presenting with cardiac issues.