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American Journal of Medical Case Reports. 2020, 8(2), 56-59
DOI: 10.12691/AJMCR-8-2-5
Case Report

Vagal-induced Complete Heart Block during Coronary Angiography due to Bladder Distention

Lyudmila Aurora1, Abid Ullah2, Pramod Theetha Kariyanna1, Oleg Yurevich1, Harshith Priyan Chandrakumar2, Erdal Cavusoglu1, Jonathan D. Marmur1 and Isabel M. McFarlane1,

1Division of Cardiovascular Diseases, Department of Medicine, State University of New York Health Sciences University, Downstate Medical Center, Brooklyn, NY 11203, U.S.A.

2Department of Internal Medicine, State University of New York Health Sciences University, Downstate Medical Center, Brooklyn, NY 11203, U.S.A.

Pub. Date: January 06, 2020

Cite this paper

Lyudmila Aurora, Abid Ullah, Pramod Theetha Kariyanna, Oleg Yurevich, Harshith Priyan Chandrakumar, Erdal Cavusoglu, Jonathan D. Marmur and Isabel M. McFarlane. Vagal-induced Complete Heart Block during Coronary Angiography due to Bladder Distention. American Journal of Medical Case Reports. 2020; 8(2):56-59. doi: 10.12691/AJMCR-8-2-5

Abstract

Vagal stimulation is common during angiographic procedures. A vasovagal reaction in the setting of coronary angiography most commonly presents as hypotension and/or bradycardia. While the array of signs and symptoms of vasovagal reactions are known, atrioventricular (AV) block maybe overlooked due to its intermittent nature. Below we describe a case of a 47 year-old female who presented with transient complete AV block, mediated by a vagal reaction due to bladder distention in the setting of an invasive coronary angiography procedure.

Keywords

vasovagal, paroxysmal atrioventricular block, extrinsic atrioventricular block bladder distention, Bezold-Jarisch reflex

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Kern M.J: Hypotension in the Cath lab? Think vagal reaction early. Cath Lab Digest. Feb 2012; 20: Issue 2
 
[2]  Al-Sadawi M., Garcia A.N., Ihsan M., Cavusoglu E., McFarlane S.I. Bladder Distension: An Overlooked Cause Vagal-induced Hypotension during Coronary Angiography. Am J Med Case Rep. 2019; 7(8): 180-183.
 
[3]  Pirola F.T., Potter V.K., Vagal action on atrioventricular conduction and its inhibition by sympathetic stimulation and neuropeptide Y in anaesthetized dogs. J Auton Nerv Syst. 1990 Sep; 31(1): 1-12.
 
[4]  Kern MJ ed. The Cardiac Catheterization Handbook, 5th ed. Philadephia, PA: Elsevier; 2011.
 
[5]  Landau C, Lange RA, Brent Glamann D, Willard JE, & David Hillis L (1994). Vasovagal reactions in the cardiac catheterization laboratory. The American Journal of Cardiology, 73(1), 95-97.
 
[6]  Gedela M., Kumar V., Shaikh K.A., Stys A., and Tomasz S. Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal. Case Rep Vasc Med. 2017; 2017: 8538149.
 
[7]  Aksu T., Guler T.E., Bozyel S., Mutluer F.O., Golcuk S.E., Yalin K. Electroanatomic-mapping-guided cardio-neuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. Journal of Interventional Cardiac Electrophysiology 54 (2), 177-188.
 
[8]  Yamaguchi Y, Tsuchiya M, Akiba T, Yasuda M, Kiryu Y, Fuzishiro Y, et al. Action of autonomic nervous reflex arising from visceral organs upon the heart. Acta Neuroveg. 1966; 28: 224-33.
 
[9]  Aste M., Brignole M. Syncope and paroxysmal atrioventricular block. J Arrhythm 2017 Dec; 33(6): 562-567.
 
[10]  Moya A., Sutton R., Ammirati F. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) Eur Heart J. 2009; 30: 2631-2671.
 
[11]  Lee S., Wellens J.J., Josephson M. Paroxysmal atrioventricular block. Heart Rhythm. 2009; 6:1229-1234.
 
[12]  Sud S., Klein G., Skanes A. Implications of mechanism of bradycardia on response to pacing in patients with unexplained syncope. Europace. 2007; 9:312-318.
 
[13]  Brignole M., Moya A., Menozzi C. Proposed electrocardiographic classification of spontaneous syncope documented by an implantable loop recorder. Europace 2005;7;14-18.
 
[14]  Zysko D., Gajek J., Kozluk E. Electrocardiographic characteristics of atrioventricular block induced by tilt testing. Europace. 2009; 11: 225-230.