Exercise induced atrio-ventricular (AV) block during nuclear perfusion stress testing: a case report

Filippo Maria Sarullo, Salvatore Accardo, Paola D’Antoni, Annamaria Martino, Antonio Micari, Vincenzo Pernice, Antonio Castello
  • Filippo Maria Sarullo
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy | fsarullo@neomedia.it
  • Salvatore Accardo
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy
  • Paola D’Antoni
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy
  • Annamaria Martino
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy
  • Antonio Micari
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy
  • Vincenzo Pernice
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy
  • Antonio Castello
    Department of Cardiology - Buccheri La Ferla Fatebenefratelli Hospital, 1 Medicina Nucleare s.r.l., and 2 Emodinamic Service Villa Maria Eleonora Hospital - Palermo, Italy

Abstract

Background. Exercise causes enhanced sympathetic discharge and results in physiologic tachycardia. However, in some patients with a diseased conduction system resulting from acute ischemia, exercise can precipitate heart block. Methods and results. In this report we describe a 51 years old male patient with transient advanced degree atrioventricular (AV) block developed during recovery from exercise stress testing, resolved after the administration of atropine. Nuclear perfusion imaging demostrated stress-induced ischemia of the inferior-apical segments, and recovery of perfusion in the images obtained at rest. Coronarography showed critical stenosis of the right coronary artery, which was treated by percutaneous coronary intervention (PCI) and drug eluting stent (DES) deployment. Conclusion. Nuclear myocardial perfusion imaging provides noninvasive evidence that transient ischemia of the infero- apical segment can result in advanced degree AV block in patient with critical severe right coronary disease.

Keywords

atrio-ventricular block, nuclear myocardial perfusion imaging, exercise stress testing

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Submitted: 2016-01-26 14:25:15
Published: 2016-01-26 14:37:28
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Copyright (c) 2016 Filippo Maria Sarullo, Salvatore Accardo, Paola D’Antoni, Annamaria Martino, Antonio Micari, Vincenzo Pernice, Antonio Castello

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