EXERTIONAL SYNCOPE IN A PATIENT WITH AORTIC-STENOSIS AND RIGHT CORONARY-ARTERY DISEASE

A female with advanced aortic valvular stenosis and moderate right coronary artery disease experienced an exertional syncope during 24-h ambulatory electrocardiography monitoring. A progressively bradycardia with 90-s sinus node arrest (cardio-inhibitory response) and premonitory angina pectoris with significant ST segment changes were demonstrated. Our report supports the concept of a neurocardiogenic (vasovagal) mechanism of exertional syncope in patients with aortic stenosis. The predominant left ventricular inferior-wall myocardial ischaemia in our patient might be an additional stimulus to left ventricular mechanoreceptors, resulting in a profound cardio-inhibitory response.