Department of Molecular and Internal Medicine, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
J Cardiol. 2008 Aug;52(1):59-61. doi: 10.1016/j.jjcc.2008.03.009. Epub 2008 Jun 19.
Although high-degree atrioventricular (AV) block in patients with a history of syncope usually requires pacemaker implantation, therapeutic strategies should also be considered. A 35-year-old man presented with complaints of palpitations, nausea and dysgeusia. Since aged 30, the patient had experienced three episodes of syncope. Holter monitoring showed transient high-degree AV block (up to 5:4 block) associated with nausea, eructation and dysgeusia irrelevant to posture as well as ventricular ectopic beats with palpitation. A head-up tilt test revealed neurally mediated vasodepression but electrophysiological study showed no abnormalities. These results indicated that his transient high-degree AV block was functional, and syncope would have been because of neurally mediated vasodepression, not bradycardia. After administration of disopyramide at 300 mg daily, the symptoms subsided and ventricular ectopic beats and AV block disappeared. He has been well for 20 months.
尽管有晕厥病史的患者发生高度房室（AV）阻滞通常需要植入起搏器，但也应考虑治疗策略。一名 35 岁男性因心悸、恶心和味觉障碍就诊。自 30 岁以来，该患者已出现三次晕厥。动态心电图监测显示短暂的高度 AV 阻滞（最高达 5:4 阻滞），与体位无关，伴有恶心、呃逆和味觉障碍，以及心悸时出现室性异位搏动。直立倾斜试验显示神经介导的血管舒张，但电生理研究无异常。这些结果表明他的短暂高度 AV 阻滞是功能性的，晕厥是由于神经介导的血管舒张，而不是心动过缓。每日给予 300mg 双异丙吡胺后，症状缓解，室性异位搏动和 AV 阻滞消失。他已经无症状 20 个月了。
