case_images: PMC9977631_01
case_images: EKG on admission.. Sinus bradycardia with first-degree AV block (red arrow), left atrial enlargement, and non-specific findings of intraventricular conduction block (blue arrow). PR, QRS, and QTc intervals are 228, 128, and 532 in milliseconds, respectively. EKG: electrocardiogram.
case_images: cureus-0015-00000034414-i01.jpg
case_images: PMC9977631_01_cureus-0015-00000034414-i01.jpg
case_images: FIG1
case_images: Electrocardiogram (EKG) was notable for sinus bradycardia, a historical right bundle branch block, a new first-degree atrioventricular block, and a new prolonged QTc (Figure 1).
case_images: Right coronary system angiography.. Large right coronary artery without significant occlusion.. Left coronary system angiography.. Normal-sized left anterior descending artery and circumflex artery. Moderately tortuous vessels with mild luminal irregularities.. Parasternal long axis.. Severe concentric LVH. Significant increase in posterior left ventricular wall thickness. Preserved left ventricle cavity size. Aortic sclerosis without stenosis. LVH: left ventricular hypertrophy.. Apical four-chamber.. Hyperdynamic global left ventricular systolic function. Reduced average global longitudinal strain pattern of 8.87% with strain pattern consistent with apical sparing described as "cherry on top."
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case_images: PMC9977631_01_.jpg
case_images: VID1
case_images: Oral metoprolol tartrate 25 mg was initiated with the subsequent development of a complete heart block (Figure 2).
case_images: EKG after beta-blocker initiation.. Sinus bradycardia with AV dissociation (red arrow) and wide QRS rhythm. Non-specific intraventricular conduction block continued. QRS and QTc intervals are 126 and 448 in milliseconds, respectively. EKG: electrocardiogram.
case_images: cureus-0015-00000034414-i02.jpg
case_images: PMC9977631_01_cureus-0015-00000034414-i02.jpg
case_images: FIG2
case_images: The cMRI was markedly abnormal, and the impression was concerning for late-stage FD with patchy late gadolinium enhancement (LGE) in the left ventricle and extensive LGE involving the inferolateral base to apex region (Figure 3). The electrophysiology team placed a dual chamber pacemaker and implantable cardioverter defibrillator due to concern for worsening future bradyarrhythmia and sudden death.