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


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.


CONCLUSIONS
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.
Sarullo
Filippo Maria
FM
Department of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy. fsarullo@neomedia.it
Accardo
Salvatore
S
D'Antoni
Paola
P
Martino
Annamaria
A
Micari
Antonio
A
Pernice
Vincenzo
V
Castello
Antonio
A
D015906:Angioplasty, Balloon, Coronary; D054537:Atrioventricular Block / Q000188:drug therapy / Q000209:etiology*; D001285:Atropine / Q000627:therapeutic use; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D054855:Drug-Eluting Stents; D005080:Exercise Test / Q000009:adverse effects*; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon
D001285:Atropine