Seizures of sternal pain in a patient with a prostheticmitral valve and an implanted single-chamber pacemaker

Authors: Magomedova N.M., Filatov A.G., Kazanovskaya S.N., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2019-13-4-375-380

For citation: Magomedova N.M., Filatov A.G., Kazanovskaya S.N., Golukhova E.Z. Seizures of sternal pain in a patient with a prosthetic mitral valve and an implanted single-chamber pacemaker. Creative Cardiology. 2019; 13 (4): 375–80 (in Russ.). DOI: 10.24022/ 1997-3187-2019-13-4-375-380

Received / Accepted:  07.12.2019/16.12.2019

Keywords: apical stimulation of the right ventricle frequency adaptation sensor myocardial ischemia heart failure

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Abstract

The article presents a clinical case of a patient with a prosthetic mitral valve implanted with a pacemaker in VVIR mode with stimulation of the right ventricle from the apex, typical angina attacks due to disruption of the frequency adaptation sensor. A significant difficulty is the exclusion of stress-induced ischemia in patients dependent on pacing, as shortness of breath can be regarded as the equivalent of angina pectoris. In patients with constant pacemaking, when detecting stress-induced disorders of contractility, coronary angiography is the only way to exclude coronary heart disease. In patients with pacemakers equipped with a frequency adaptation function, an excessive increase in the frequency of stimulation (the so-called sensor-mediated tachycardia) is often found. Episodes of tachycardia can induce ischemia, cause myocardial infarction. Using the method of Holter monitoring, it is possible to identify the relationship of patient complaints with a change in the operation of the pacemaker, the selection of an adequate, individual for each patient, pacemaking mode. In the presented clinical case, using the method of Holter monitoring, it was possible to find out the cause of anginal pain in the patient and successfully eliminate it. For a patient with constant pacing, individual and careful selection of the frequency adaptation mode is extremely important. Several stress tests, Holter monitoring, lengthy telemetry tests may be required before the patient feels comfortable.

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About Authors

  • Nargiz M. Magomedova, Cand. Med. Sc., Cardiologist, Researcher, ORCID
  • Andrey G. Filatov, Dr. Med. Sc., Head of Laboratory, ORCID
  • Svetlana N. Kazanovskaya, Researcher, ORCID
  • Elena Z. Golukhova, Dr. Med. Sc., Academician of Russian Academy of Sciences, Head of Department, Acting Director, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery