Iatrogenic atrio-ventricular conduction disorders – an unexpected possibility in young patients

Introduction: In era of polymedication, adverse effects of drugs are beginning to be a reality, so, considered rigorous follow-up is requiring. Over time, a multitude of drug classes have been incriminated as responsible for the occurrence of various types of atrio-ventricular conduction disorders. These disorders may range from low-risk arrhythmias such as the first-degree atrio-ventricular block to a life-threatening diseases such as the third degree or complete atrioventricular block.
Case presentation: We present the case of a 44-year-old female patient diagnosed two months ago with angina pectoris and admitted to our hospital, with chest pain for 30 minutes. At home, our patient underwent beta-blocker, antiplatelete and hypolipidemic treatment. From the patient’s history, it is revealed that the chest pain is effort-related, but also mechanical. The electrocardiogram reveals negative T-wave in the anterior territory. Cardiac markers are dosed at presentation and after 4 hours, within normal thresholds. During investigations, the patient develops a syncope, with the ECG revealing a jonctional rhythm of 30/ min.Taking into account the recent history and ECG changes, the patient’s hospitalization and angiographic assessment of the coronary arteries are decided. Also, the beta-blocker treatment is discontinued. Coronarography performed the next day, reveales normal coronary arteries. EKG holter monitoring is performed in the absence of bradycardic medication, without significant sinusal pauses being noted, thus suggesting the iatrogenic origin of the conduction disorder. The patient was successfully discharged without repeating any bradycardic disorder.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)