Article Details

Pulmonary embolism (PE) is a challenging diagnosis due to its varied presentations and association with multiple electrocardiographic (ECG) abnormalities. This case report highlights a rare presentation of PE manifesting as transient complete heart block (CHB) in an 85-year-old male. The patient, with a history of hypercholesterolaemia and gastro-oesophageal reflux disease, presented with syncope, severe chest pain, and bradycardia. Initial ECG revealed CHB with a right bundle branch block morphology. Diagnostic imaging confirmed extensive bilateral PE with significant thrombus burden and right ventricular strain. Management included therapeutic anticoagulation with enoxaparin, leading to resolution of CHB without the need for pacing intervention.

The case underscores the pathophysiology of transient CHB in the context of PE, likely due to acute right ventricular strain exacerbating a pre-existing left bundle branch block. It highlights the importance of considering PE in elderly patients presenting with unexplained cardiac arrhythmias, particularly in the presence of conduction abnormalities. This report adds to the limited literature on transient CHB as a reversible complication of PE, emphasising the potential for non-invasive management and the importance of maintaining a high clinical suspicion for PE in atypical presentations.

Learning Objective: To recognise pulmonary embolism as a potential cause of transient complete heart block, understand its pathophysiology in the context of right ventricular strain, and emphasise the importance of considering PE in patients presenting with unexplained arrhythmias or atypical symptoms for timely diagnosis and effective medical management.

Keywords: Complete heart block; Atrioventricular block; Pulmonary embolism; Arrythmia