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

A female with advanced aortic valvular stenosis and moderate right cor onary artery disease experienced an exertional syncope during 24-h amb ulatory electrocardiography monitoring. A progressively bradycardia wi th 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) me chanism of exertional syncope in patients with aortic stenosis. The pr edominant left ventricular inferior-wall myocardial ischaemia in our p atient might be an additional stimulus to left ventricular mechanorece ptors, resulting in a profound cardio-inhibitory response.