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Fortuitous Identification of Fluctuating AV Block: A Case Report.
Journal Title
The Journal of emergency medicine
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Publication Date
2019-05-06
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Publication Volume
57
Publication Issue
1
Publication Begin
e9
Publication End
e12
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Abstract
Vagally mediated atrioventricular block (AVB) may occur as a result of increased parasympathetic tone. This particular AVB is infrequently described in the literature, but its prevalence may be underestimated, as it may occur without recognition.
We present a case of vagally mediated AVB that was identified by serial electrocardiography of a patient who presented to the emergency department with vomiting. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Vagally mediated AVB must be differentiated from paroxysmal, bradycardia-dependent AVB, which may progress to persistent AVB and require pacemaker placement. In an asymptomatic patient with vagally mediated AVB, pacemaker placement is contraindicated. However, if symptoms are clearly attributable to vagally mediated AVB, pacemaker placement may be reasonable.
We present a case of vagally mediated AVB that was identified by serial electrocardiography of a patient who presented to the emergency department with vomiting. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Vagally mediated AVB must be differentiated from paroxysmal, bradycardia-dependent AVB, which may progress to persistent AVB and require pacemaker placement. In an asymptomatic patient with vagally mediated AVB, pacemaker placement is contraindicated. However, if symptoms are clearly attributable to vagally mediated AVB, pacemaker placement may be reasonable.
Citation
deSouza IS, Dilip M. Fortuitous Identification of Fluctuating AV Block: A Case Report. J Emerg Med. 2019 Jul;57(1):e9-e12. doi: 10.1016/j.jemermed.2019.03.033. Epub 2019 May 6. PMID: 31072656.