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Syncope and palpitation in a patient following aortic valve replacement

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ROGER HALL, MARK, EARLEY, HAMMERSMITH HOSPITAL, LONDON, UK

A usually very fit man aged 90 presented with syncope and angina of effort. He was found to have severe calcific aortic stenosis and associated coronary disease restricted to the left anterior descending (LAD) coronary artery.

He underwent an aortic valve replacement with tissue prosthesis and a single coronary graft to the LAD. He came off bypass without difficulty but on the third postoperative period,when he had left the intensive care unit and was making excellent progress mobilising, he had further episodes of syncope and also developed palpitations.

The significance of these symptoms and the diagnosis and treatment of these postoperative problems is discussed in an interactive case presentation.

The purpose of this interactive case presentation is to illustrate:

  • The incidence, predisposing factors, and significance in the postoperative period of:

    • supraventricular arrhythmias

    • bradycardia and complete heart block

  • The potential for prophylactic treatment to reduce the incidence of rhythm problems

  • The management of supraventricular arrhythmias and particularly atrial fibrillation postoperatively

  • When permanent pacing is needed for postoperative bradycardia.

This interactive case history is hosted on BMJ Learning—the best available learning website for medical professionals from the BMJ Group.

To access the interactive case, please use the [Take this module on BMJ Learning] link from the online article content box or table of contents.

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