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Syncope after aortic valve surgery

  • C. CrooijmansEmail author
  • L. M. Rademakers
Open Access
Rhythm Puzzle – Question
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A 49-year-old man with a bicuspid aortic valve with severe stenosis and moderately depressed left ventricular ejection fraction underwent implantation of a mechanical aortic prosthesis. During the pre-operative evaluation, the electrocardiogram (ECG) showed sinus rhythm with first-degree atrioventricular block and voltage criteria of left ventricular hypertrophy (Fig. 1).
Fig. 1

ECG during pre-operative evaluation

On the fourth postoperative day, the patient complained of sudden onset of rapid palpitations. The ECG is shown in Fig. 2. Both carotid sinus massage and a rapid intravenous bolus of 20 mg adenosine did neither temporarily slow down nor stop the tachycardia. Meanwhile, his blood pressure had declined to 70/40 mm Hg. A few minutes later, the patient lost consciousness and underwent immediate direct-current (DC) cardioversion. What is your diagnosis?
Fig. 2

ECG during rapid palpitations

Answer

You will find the answer elsewhere in this issue.

Copyright information

© The Author(s) 2019

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  1. 1.Department of CardiologyCatharina ZiekenhuisEindhovenThe Netherlands

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