case_images: PMC7453273_01
case_images: Electrocardiogram revealing complete heart block with a ventricular escape at approximately 48 beats per minute.
case_images: CRIC2020-7614836.001.jpg
case_images: PMC7453273_01_CRIC2020-7614836.001.jpg
case_images: fig1
case_images: On assessment in the emergency department, the patient was found to be in complete heart block (CHB) with a ventricular escape of 48 bpm (Figure 1).
case_images: Transthoracic echocardiogram performed on presentation. Apical 4 chamber view, at end diastole (a) and end systolic (b) demonstrating left ventricular apical hypokinesis.
case_images: CRIC2020-7614836.002.jpg
case_images: PMC7453273_01_CRIC2020-7614836.002.jpg
case_images: fig2
case_images: The coronary angiogram revealed nonobstructive coronary artery disease, with a focal 50% stenosis in the midleft circumflex coronary artery (supplemental figure 2).
case_images: Cardiac catheterisation performed on day 9, left ventriculogram at end diastole (a) and end systole (b) demonstrating resolution of the apical hypokinesis.
case_images: CRIC2020-7614836.003.jpg
case_images: PMC7453273_01_CRIC2020-7614836.003.jpg
case_images: fig3
case_images: The left ventriculogram performed revealed near normalisation of the apical hypokinesis and an elevated end diastolic pressure of 20 mmHg (Figure 3).
case_images: Electrocardiogram following implantation of a dual chamber pacemaker with atrial sensed, ventricular paced complexes.
case_images: CRIC2020-7614836.004.jpg
case_images: PMC7453273_01_CRIC2020-7614836.004.jpg
case_images: fig4
case_images: Nine days after presentation, once the patient was able to lie flat without incident, a dual chamber Biotronik pacemaker was implanted, DDD 60-130 (Figure 4).