title: Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block.
abstract: This study describes a case of exercise-induced myocardial ischaemia accompanied by complete atrioventricular block (CAVB). A 59-year-old man with major depression, treated with regular imipramine and lithium for 20 years, experienced syncope episodes during exercise. Exercise, testing initially, identified ST depression in the inferior leads, and later found CAVB resulting in syncope and seizure. The patient recovered completely after resuscitation. Myocardial ischaemic markers were negative, but 35% stenosis was detected in the distal left main coronary artery by angiography. The combined use of verapamil, nitrate and aspirin was treated as the possible coronary spasm. Repeat treadmill caused negative ischaemic study or exercise-induced arrhythmia, 7 days later. The pathophysiology of the very rare exercise-induced paroxysmal CAVB has been reviewed.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: W J
authors.initials: WJ
authors.lastname: Ho
authors.forename: P H
authors.initials: PH
authors.lastname: Chu
authors.forename: N J
authors.initials: NJ
authors.lastname: Cheng
authors.forename: T S
authors.initials: TS
authors.lastname: Hsu
authors.forename: Y S
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects; D004562:Electrocardiography; D015444:Exercise; D006327:Heart Block / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*
chemical_list: D000928:Antidepressive Agents