Exertional syncope in a patient with aortic stenosis and right coronary artery disease.
A female with advanced aortic valvular stenosis and moderate right coronary artery disease experienced an exertional syncope during 24-h ambulatory electrocardiographic monitoring. A progressive bradycardia with 90-s sinus node arrest (cardio-inhibitory response) and premonitory angina pectoris with significant ST segment changes were demonstrated. Our report supports the concept of a neurocardiogenic (vasovagal) mechanism of exertional syncope in patients with aortic stenosis. The predominant left ventricular inferior-wall myocardial ischaemia in our patient might be an additional stimulus to left ventricular mechanoreceptors, resulting in a profound cardio-inhibitory response.
Sinkovec
M
M
Clinic of Cardiology, University Medical Centre, Ljubljana, Slovenia.
Rakovec
P
P
Zorman
D
D
Antolic
G
G
Grad
A
A
D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000503:physiopathology; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D005082:Physical Exertion; D013575:Syncope / Q000209:etiology*