Cor Vasa 2005, 46(1):14-17
Manifestation of Bezold-Jarisch reflex in the course of exercise stress testing. A case report.
- 1 I. interní klinika
- 2 Oddělení kardiochirurgie, Fakultní nemocnice Plzeň-Lochotín, Plzeň, Česká republika
We present the case of a 63-year-old man with syncope while walking. Based on elevation of myocardial necrosis markers, a non-Q-wave myocardial infarction of uncertain localization was diagnosed upon admission. Echocardiography documented moderate aortic stenosis, while coronary angiography and cardiac catheterization revealed a tight stenosis of the left circumflex and right coronary arteries unsuitable for percutaneous coronary intervention (PCI); the peak-to-peak aortic transvalvular gradient was 35 mm Hg. ECG-Holter monitoring did not show arrhythmia, perfusion lung scan excluded pulmonary embolism. Bicycle ergometry was terminated at a workload of 100 W due to ST-segment elevation in leads III, aVF with Bezold-Jarisch reflex manifestation (hypotension, sinus bradycardia), fatigue and dyspnoe, without chest pain. Based on the result of bicycle ergometry, the patient underwent CABG with aortic valve replacement. After discharge, the patient is without syncope recurrence; follow-up bicycle ergometry 4 months later showed normal increases in blood pressure and heart rate, with sustained lower maximal work capacity of 4.8 METs.
Keywords: Exercise stress test; Hypotension; Bradycardia; CABG
Published: January 1, 2005 Show citation