Complete atrioventricular block caused by pulmonary embolism: A case report and review of literature

Olson, Peter C.; Cinelli, M; Kurtovic, Edmond; Barsoum, Emad; Spagnola, Jonathan; Lafferty, James

doi:10.1016/j.hrtlng.2019.06.002

Cited by 2 publications

(4 citation statements)

References 11 publications

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“…Some rare findings described in case reports include electrical alternans ( 12 ) and ST-segment elevation in lead aVR, with ST-segment depression in leads I and V4-V6 ( 13 ). Specifically, the RBBB has been identified as an indicator of RV strain found in more severe cases of PE, with reported incidences ranging from 6% to 67% ( 8 ). However, the prognostic significance of an ECG result indicating RV strain remains inconclusive ( 14 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Complete atrioventricular block in an elderly patient with acute pulmonary embolism

Kim,

Seo,

Kim

et al. 2024

Front. Cardiovasc. Med.

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IntroductionMultiple abnormal electrocardiographic findings have been documented in patients experiencing acute pulmonary embolism. Although sinus tachycardia is the most commonly encountered rhythmic disturbance, subsequent reports have highlighted other findings. These include right bundle branch block, right axis deviation, nonspecific ST segment/T wave changes, and T wave inversion in the right precordial leads. To date, only a limited number of cases involving a complete atrioventricular block have been reported in acute pulmonary embolism.Case presentationHere, we present the case of a 91-year-old woman with acute pulmonary embolism, whose initial electrocardiogram showed a complete atrioventricular block. She presented with presyncope and an initial blood pressure of 77/63 mmHg. Echocardiography confirmed signs of right ventricular dysfunction. Catheter-directed thrombolysis and a temporary pacemaker insertion were carried out sequentially. The following day, electrocardiography showed sinus rhythm with a left bundle branch block.DiscussionThe presence of a complete atrioventricular block in patients with acute pulmonary embolism serves as a clinical marker of high-risk status.

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Section: Discussionmentioning

confidence: 99%

“…However, the incidence of complete atrioventricular block (CAVB) remains rare and noteworthy in patients with PE. Only a limited number of cases have been reported in the literature ( 3 – 8 ). Herein, we present the case of a 91-year-old woman who presented with CAVB and review the relevant literature.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Complete atrioventricular block in an elderly patient with acute pulmonary embolism

Kim,

Seo,

Kim

et al. 2024

Front. Cardiovasc. Med.

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show abstract

“…Our case describes a patient with no known history of arrhythmias or heart disease presenting with a PE that led to acute changes in her cardiopulmonary physiology resulting in hemodynamic collapse. In PE, the pulmonary artery obstruction leads to a rise in the right ventricular pressures and a volume overload state [ 4 ]. With this volume expansion, the right ventricle may compress the interventricular septum leading to a new RBBB on the EKG.…”

Section: Discussionmentioning

confidence: 99%

“…If the patient is still in complete heart block post-treatment of PE, a long-term pacemaker device can be placed. If the heart block is resolved, then an EP study can be done to evaluate whether or not the patient requires or will benefit from a long-term pacemaker [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism

Ghallab¹,

Tran²,

Shahid³

et al. 2023

Cureus

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Presentations of pulmonary embolism (PE) are often associated with various cardiac arrhythmias and conduction abnormalities detected on electrocardiograms (EKG). We describe a 65-year-old female with no known history of heart disease or arrhythmias who presented with an acute onset of shortness of breath. Initial EKG showed right bundle branch block (RBBB), and first-degree atrioventricular (AV) block with subsequent development of second-degree Mobitz type II AV block. The patient's clinical appearance was highly suggestive of a massive pulmonary embolism with hemodynamic instability, and treatment with alteplase (tPA) was given, followed by heparinization. A CT pulmonary angiography confirmed the provisional diagnosis and revealed a large saddle embolus within the right and left main pulmonary arteries. Subsequent EKG showed resolution of the RBBB, first-degree AV block, and second-degree AV block. The patient improved clinically and was discharged to a subacute rehab facility with follow-up appointments. This case highlights that pulmonary embolism may present with many EKG changes, including RBBB, firstdegree, second-degree, or complete heart block. Early recognition of PE and thrombolytic treatment can improve cardiac function and restore heart rhythms. Further evaluation for underlying conduction abnormalities can later be performed.

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Complete atrioventricular block caused by pulmonary embolism: A case report and review of literature

Cited by 2 publications

References 11 publications

Case Report: Complete atrioventricular block in an elderly patient with acute pulmonary embolism

Case Report: Complete atrioventricular block in an elderly patient with acute pulmonary embolism

A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism

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