Right Coronary Artery Vasospasm Presenting as Complete Atrioventricular Block

Recurrent syncope driven by unique‐variant angina pectoris

“…The fourth 24‐h dynamic ECG caught the syncope attack and showed a combined Type II (2:1 downward transmission) and Type I second‐degree AV block, and the leads of the ST segment elevation were II, III, and avF (Figure 3), which are lower‐wall leads of the RCA blood‐supplying territory, which is consistent with the CAG finding of mild stenosis in the RCA (Figure 2B). Because 93% of the blood supply of the AV node originates from the RCA, 8 an RCA spasm appears to have reduced or blocked the blood supply of the AV node in our patient, 5 leading to the emergence of arrhythmia, including the second‐degree II AV block and/or an even higher‐degree AV block.…”

“…Fortunately, the ambulatory ECG caught the patient's syncope attack showing sinus rhythm, atrial premature beat (101 times), short atrial tachycardia (one time), and ST‐segment elevated 0.1–0.2 mV in the II, III, and avF leads along with a combined Type II (2:1 downward transmission) and Type I second‐degree atrioventricular (AV) block (Figure 3). These findings suggested that a right coronary spasm may have caused the inferior wall myocardium, AV node ischemia, and severe arrhythmias including the Type II second‐degree AV block, leading to the patient's syncope 5 …”

“…These findings suggested that a right coronary spasm may have caused the inferior wall myocardium, AV node ischemia, and severe arrhythmias including the Type II second-degree AV block, leading to the patient's syncope. 5 Variant angina refers to a segmental or diffuse reversible spasmodic contraction of coronary artery smooth muscle in the epicardium, which leads to chest tightness, chest pain, arrhythmia, and syncope. 6,7 In our patient's case, the sign of angina pectoris was not chest tightness/ typical pain, but a feeling of needing to defecate.…”

A Common Electrocardiogram Demonstrating an Uncommon Cause

“…While this patient’s ECG demonstrated ST-segment elevation, it should be noted that CAS can present with a range of clinical conditions, including myocardial necrosis, syncope, arrhythmias (such as ventricular tachycardia and complete atrioventricular block), and cardiac arrest . Therefore, prominent J waves with ST-segment elevation should be critically observed in patients with myocardial ischemia.…”

Angina and Arrhythmia Symptoms Following Multiple Bee Stings: Kounis Syndrome

“…11 Because the right coronary artery supplies the AV nodal artery, its occlusion and/or vasospasm may lead to abnormalities of the AV conduction system. 12 Therefore, the most likely explanation for bradycardia in Type I KS may be vasospasm stemming from allergic causes in the right coronary artery due to the degranulation of mast cells. Coronary vasospasm or stenosis may be demonstrated by cardiac catheterization.…”