Heart Block and Sinus Pause Following Abdominal Surgery: A Case Requiring Temporary Pacemaker Insertion.

Area of Science:

• Cardiology
• Gastroenterology
• Critical Care Medicine

Background:

• Abdominal surgery can precipitate various complications, including cardiac events.
• Post-operative bradycardia and sinus pauses are potential, though less common, sequelae.

Observation:

• A 70-year-old female with hypertension presented with altered mental status and abdominal pain, diagnosed with small bowel obstruction and perforated appendix.
• Following appendectomy and supportive care, the patient developed significant bradycardia with sinus pauses and complete heart block.
• Cardiology attributed the cardiac rhythm disturbances to increased parasympathetic tone post-surgery.

Findings:

• The patient required a temporary transvenous pacemaker due to symptomatic bradycardia and sinus pauses.
• Successful management involved close monitoring and temporary cardiac pacing.
• Resolution of sinus pauses and return of normal sinus rhythm occurred as the patient recovered.

Implications:

• This case highlights the critical need for vigilance regarding cardiac complications, specifically sinus pauses, after major abdominal surgery.
• Prompt recognition and multidisciplinary management involving surgery and cardiology are crucial for optimal patient outcomes.
• Understanding the interplay between surgical stress, parasympathetic tone, and cardiac function is essential in post-operative care.