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A 69-year-old female patient, with a history of hypertension and type 2 diabetes mellitus, was referred to our organization for an episode of intense dizziness and heart rate of 35bpm. A second grade 2:1 atrioventricular (AV) nodal block was identified, followed by sinus rhythm. Dizziness improved after return to sinus rhythm. The patient denied chest pain, dyspnea and syncope. The physical examination was normal and the electrocardiogram showed left ventricular overload. She was admitted to the coronary unit, evolved with complaint of dizziness, being identified again a second-grade 2:1 AV nodal block, and a provisional pacemaker implantation was indicated. From then on, after brachial vein access provisional pacemaker implantation, the patient developed chest pain and increased levels of ultra-sensitive troponin (305ng/mL; 12,529ng/mL; 3,525ng/mL; 1,158ng/mL; upper reference value of 60.00ng/mL).

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