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Exertional syncope in a patient with aortic stenosis and right coronary artery disease.

Author(s): P Rakovec, A Grad, D Zorman, M Sinkovec, G Antolic

Publication date: 1995-01-31

Keywords: Aged, Aortic Valve Stenosis, complications, physiopathology, Coronary Disease, Electrocardiography, Ambulatory, Female, Humans, Physical Exertion, Syncope, etiology

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Abstract

A female with advanced aortic valvular stenosis and moderate right coronary artery disease experienced an exertional syncope during 24-h ambulatory electrocardiographic monitoring. A progressive bradycardia with 90-s sinus node arrest (cardio-inhibitory response) and premonitory angina pectoris with significant ST segment changes were demonstrated. Our report supports the concept of a neurocardiogenic (vasovagal) mechanism of exertional syncope in patients with aortic stenosis. The predominant left ventricular inferior-wall myocardial ischaemia in our patient might be an additional stimulus to left ventricular mechanoreceptors, resulting in a profound cardio-inhibitory response.