case_images: PMC8035013_01
case_images: The initial electrocardiogram in the emergency department shows complete atrioventricular block with a heart rate of 40 beats/minute and T-wave inversion in the I, II, aVL, aVF, and V3-6 leads.
case_images: CRIC2021-6637720.001.jpg
case_images: PMC8035013_01_CRIC2021-6637720.001.jpg
case_images: fig1
case_images: Initial electrocardiography revealed complete AV block with a junctional escape rate of 40 beats/minute, and T-wave inversion in these leads: I, II, aVL, aVF, and V3-6 (Figure 1).
case_images: On hospital day 8, a coronary angiogram shows no stenosis: (a) right coronary artery; (b) left coronary artery. Left ventricular angiography shows hypokinesis from the midventricle to the apex and hyperkinesis in the basal segments: (c) end-diastole; (d) end-systole.
case_images: CRIC2021-6637720.002.jpg
case_images: PMC8035013_01_CRIC2021-6637720.002.jpg
case_images: fig2
case_images: On hospital day 8, coronary angiography showed no significant stenosis, and left ventriculography revealed apical ballooning (Figure 2).
case_images: Echocardiogram shows gradual improvement of left ventricular systolic dysfunction: (a) admission (day 0), (b) hospital day 2, (c) day 5, and (d) day 9. Yellow arrow indicates an area of abnormal wall motion in end-systole.
case_images: CRIC2021-6637720.003.jpg
case_images: PMC8035013_01_CRIC2021-6637720.003.jpg
case_images: fig3
case_images: Echocardiography showed improvement of LV abnormal wall motion gradually over admission through hospital day 9 (Figure 3); however, AV block persisted intermittently (Figure 4(a)).
case_images: Electrocardiogram shows transient advanced atrioventricular block on hospital day 2 (a) and day 14 (b).
case_images: CRIC2021-6637720.004.jpg
case_images: PMC8035013_01_CRIC2021-6637720.004.jpg
case_images: fig4
case_images: Echocardiography showed improvement of LV abnormal wall motion gradually over admission through hospital day 9 (Figure 3); however, AV block persisted intermittently (Figure 4(a)). On day 14, a pause of 5-6 seconds without LV contraction was observed (Figure 4(b)), and the patient underwent temporary pacemaker implantation.