Correlation Between Transient Hypotension and Exclusively Exercise-induced Symptoms of Two-to-One Atrioventricular Block

Hirofumi Tasaki; Shoichi Nagao; Reiichiro Nakamizo; Yuji Matsumoto; Naoto Ashizawa; Yoshiyuki Doi; Satoki Fukae; Hiroaki Kawano; Koji Maemura

doi:10.2169/internalmedicine.5261-20

This article has now been updated. Please use the final version.

Correlation Between Transient Hypotension and Exclusively Exercise-induced Symptoms of Two-to-One Atrioventricular Block

Hirofumi Tasaki, Shoichi Nagao, Reiichiro Nakamizo, Yuji Matsumoto, Naoto Ashizawa, Yoshiyuki Doi, Satoki Fukae, Hiroaki Kawano, Koji Maemura

Author information

Hirofumi Tasaki
Department of Cardiovascular Medicine, Nagasaki Genbaku Isahaya Hospital, Japanese Red Cross Society, Japan
Shoichi Nagao
Department of Cardiovascular Medicine, Nagasaki Genbaku Isahaya Hospital, Japanese Red Cross Society, Japan
Reiichiro Nakamizo
Cardiovascular Medicine, Jikei Hospital, Japan
Yuji Matsumoto
Department of Cardiovascular Medicine, Nagasaki Genbaku Hospital, Japanese Red Cross Society, Japan
Naoto Ashizawa
Department of Cardiovascular Medicine, Nagasaki Genbaku Hospital, Japanese Red Cross Society, Japan
Yoshiyuki Doi
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Satoki Fukae
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Hiroaki Kawano
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Koji Maemura
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan

Keywords: two-to-one atrioventricular block, exclusively exercise-induced symptom, transient hypotension, normal left ventricular ejection fraction, diastolic mitral and tricuspid regurgitation, treadmill test

JOURNAL OPEN ACCESS Advance online publication

Article ID: 5261-20

DOI https://doi.org/10.2169/internalmedicine.5261-20

The final version of this article is now available: Vol. 60 (2021), No. 6 pp. 891-896

Details

Abstract

A 62-year-old woman with activity-dependent two-to-one atrioventricular block (2:1AVB) and a normal left ventricular ejection fraction was referred to our department for the evaluation of exclusively exercise-induced marked symptoms. The treadmill test helped establish a clear correlation between 2:1AVB and symptoms. The test results demonstrated that exercise-induced marked symptoms were attributed to abrupt transient hypotension combined with relative bradycardia, probably due to increased diastolic mitral and tricuspid regurgitation because of 2:1AVB during moderate-to-heavy exercise. After pacemaker implantation for 2:1AVB, the symptoms and transient hypotension disappeared, and her exercise capacity improved.

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