Paroxysmal AV block case study one: Difference between revisions
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==Overview== | ==Overview== | ||
A 79 year old woman with multiple comorbidities was diagnosed with paroxysmal AV Block with the help of carotid sinus massage and prolonged ECG monitoring. She was then treatment with a dual chamber pacemaker. | A 79 year old woman with multiple comorbidities was diagnosed with [[paroxysmal AV Block]] with the help of [[carotid sinus massage]] and prolonged [[ECG]] monitoring. She was then treatment with a dual chamber [[pacemaker]]. | ||
=Patient History= | =Patient History= | ||
A 79‐year‐old hypertensive woman presented with recurrent episodes of syncope over a month, increasing in frequency over the last 3 days. | A 79‐year‐old hypertensive woman presented with recurrent episodes of [[syncope]] over a month, increasing in [[frequency]] over the last 3 days. | ||
=Diagnosis and Management= | =Diagnosis and Management= | ||
*Echocardiography revealed fair left ventricular contractility, mild aortic stenosis, marked mitral annular calcification, mild mitral stenosis and mild mitral regurgitation. | *[[Echocardiography]] revealed fair left [[ventricular]] contractility, mild [[aortic stenosis]], marked [[mitral]] annular [[calcification]], mild [[mitral stenosis]] and mild [[mitral regurgitation]]. | ||
*Baseline ECG was normal. | *Baseline ECG was normal. | ||
*Carotid sinus massage triggered a paroxysmal AV block with slowing of sinus rate, associated with | *[[Carotid sinus massage]] triggered a [[paroxysmal AV block]] with slowing of [[sinus rate]], associated with near‐[[syncope]]; | ||
[[Image:Complete AV Block with Sinus slowing during carotid Sinus massage Case report.jpg|thumb|center|500px|'''Complete AV Vlock with sinus slowing during carotid sinus massage''' {{cite web |url=https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12245 |title=What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? - Bansal - 2019 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}}]] | [[Image:Complete AV Block with Sinus slowing during carotid Sinus massage Case report.jpg|thumb|center|500px|'''Complete AV Vlock with sinus slowing during carotid sinus massage''' {{cite web |url=https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12245 |title=What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? - Bansal - 2019 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}}]] | ||
*During hospital stay, the patient went intermittently into complete AV block,often with | *During [[hospital]] stay, the patient went intermittently into [[complete AV block]],often with near‐[[syncope]]; | ||
[[Image:Single‐channel ECG recordings from ICU monitor. A, shows paroxysmal Phase 4 block triggered by a PVC. B, shows idiopathic paroxysmal AV block occurring without any obvious trigger.jpg|thumb|center|500px|'''Single‐channel ECG recordings from ICU monitor. A, shows paroxysmal Phase 4 block triggered by a PVC. B, shows idiopathic paroxysmal AV block occurring without any obvious trigger'''{{cite web |url=https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12245 |title=What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? - Bansal - 2019 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}}]] | [[Image:Single‐channel ECG recordings from ICU monitor. A, shows paroxysmal Phase 4 block triggered by a PVC. B, shows idiopathic paroxysmal AV block occurring without any obvious trigger.jpg|thumb|center|500px|'''Single‐channel ECG recordings from ICU monitor. A, shows paroxysmal Phase 4 block triggered by a PVC. B, shows idiopathic paroxysmal AV block occurring without any obvious trigger'''{{cite web |url=https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12245 |title=What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? - Bansal - 2019 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}}]] | ||
*The patient was started on isoprenaline infusion at 2 µg/min, with which the episodes subsided. | *The patient was started on [[isoprenaline]] infusion at 2 µg/min, with which the episodes subsided. | ||
*Subsequently, a '''dual‐chamber pacemaker was implanted, with alleviation of symptoms'''. | *Subsequently, a '''dual‐chamber [[pacemaker]] was implanted, with alleviation of [[symptoms]]'''. | ||
=References= | =References= | ||
{{cite web |url=https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12245 |title=What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? - Bansal - 2019 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}} | {{cite web |url=https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12245 |title=What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? - Bansal - 2019 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}} | ||
Latest revision as of 14:11, 4 July 2020
Overview
A 79 year old woman with multiple comorbidities was diagnosed with paroxysmal AV Block with the help of carotid sinus massage and prolonged ECG monitoring. She was then treatment with a dual chamber pacemaker.
Patient History
A 79‐year‐old hypertensive woman presented with recurrent episodes of syncope over a month, increasing in frequency over the last 3 days.
Diagnosis and Management
- Echocardiography revealed fair left ventricular contractility, mild aortic stenosis, marked mitral annular calcification, mild mitral stenosis and mild mitral regurgitation.
- Baseline ECG was normal.
- Carotid sinus massage triggered a paroxysmal AV block with slowing of sinus rate, associated with near‐syncope;
- During hospital stay, the patient went intermittently into complete AV block,often with near‐syncope;
- The patient was started on isoprenaline infusion at 2 µg/min, with which the episodes subsided.
- Subsequently, a dual‐chamber pacemaker was implanted, with alleviation of symptoms.