Abstract：
BACKGROUND: Bradycardia frequently occurs in heart-transplanted patients, mainly as a temporally restricted manifestation early after transplantation and often without symptoms. A high-degree atrioventricular block is mostly symptomatic through cerebral hypoxia induced through cerebral hypoperfusion. Only a few published cases show this specific electroencephalography result in this context. The purpose of this case is to bring attention to atypical manifestations of typical cardiac complications after heart transplantation and the importance of perseverance in the diagnostic.
METHODS: A Central European man in his 50s with history of heart transplantation 31 years previously was admitted to the internal medicine ward for short-lived recurrent episodes of generalized weakness with multiple falls but without loss of consciousness. During routine electroencephalography, the patient perceived this recurrent sensation. This episode coincided with a transient third-degree atrioventricular block followed 8-10 seconds later by a generalized slowing of the electroencephalography, reflecting cerebral hypoxia due to cerebral hypoperfusion. Holter monitoring confirmed the diagnosis. A pacemaker was implanted, consequently resolving the episodes.
CONCLUSIONS: This case report illustrates the pathophysiological central hypoxemic origin of episodes of generalized weakness caused by a high-degree atrioventricular block in a patient surviving 29 years after heart transplant. It highlights the benefit of electroencephalography as a diagnostic tool in well-selected patients.
METHODS: A Central European man in his 50s with history of heart transplantation 31 years previously was admitted to the internal medicine ward for short-lived recurrent episodes of generalized weakness with multiple falls but without loss of consciousness. During routine electroencephalography, the patient perceived this recurrent sensation. This episode coincided with a transient third-degree atrioventricular block followed 8-10 seconds later by a generalized slowing of the electroencephalography, reflecting cerebral hypoxia due to cerebral hypoperfusion. Holter monitoring confirmed the diagnosis. A pacemaker was implanted, consequently resolving the episodes.
CONCLUSIONS: This case report illustrates the pathophysiological central hypoxemic origin of episodes of generalized weakness caused by a high-degree atrioventricular block in a patient surviving 29 years after heart transplant. It highlights the benefit of electroencephalography as a diagnostic tool in well-selected patients.
摘要：
背景：心脏移植患者经常发生心动过缓，主要是移植后早期的时间限制表现，通常无症状。高度房室传导阻滞主要是通过脑低灌注引起的脑缺氧引起的症状。在这种情况下，只有少数已发表的病例显示了这种特定的脑电图结果。这种情况的目的是提请注意心脏移植后典型心脏并发症的非典型表现以及坚持不懈在诊断中的重要性。
方法：一名50多岁的中欧男子，31年前有心脏移植史，因短暂反复发作的全身无力，并伴有多次跌倒，但没有意识丧失而入院。在常规脑电图检查期间，病人察觉到这种反复发作的感觉。此发作与短暂的三度房室传导阻滞同时发生，随后8-10秒后，脑电图全面减慢，反映脑灌注不足导致的脑缺氧。Holter监测证实了诊断。植入了起搏器,从而解决了这些事件。
结论：该病例报告说明了心脏移植后存活29年的患者高度房室传导阻滞引起的全身无力发作的病理生理中枢低氧血症起源。它强调了脑电图作为精心选择的患者的诊断工具的好处。
方法：一名50多岁的中欧男子，31年前有心脏移植史，因短暂反复发作的全身无力，并伴有多次跌倒，但没有意识丧失而入院。在常规脑电图检查期间，病人察觉到这种反复发作的感觉。此发作与短暂的三度房室传导阻滞同时发生，随后8-10秒后，脑电图全面减慢，反映脑灌注不足导致的脑缺氧。Holter监测证实了诊断。植入了起搏器,从而解决了这些事件。
结论：该病例报告说明了心脏移植后存活29年的患者高度房室传导阻滞引起的全身无力发作的病理生理中枢低氧血症起源。它强调了脑电图作为精心选择的患者的诊断工具的好处。
