A patient with chest pain was found to have obstructive hypertrophic cardiomyopathy. After the first oral dose of propranolol, syncope developed together with atrioventricular block. An electrophysiologic study revealed an intermittent advanced (His-Purkinje) block within the atrioventricular conduction system. Caution is recommended when treatment is initiated in patients with hypertrophic cardiomyopathy in whom there is any suspicion of abnormalities in the atrioventricular conduction tissues.
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Marshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USAMarshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USA
Kasirye, Yusuf
Manne, Janaki
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Marshfield Clin Fdn Med Res & Educ, Dept Hosp Med, Marshfield, WI 54449 USAMarshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USA
Manne, Janaki
Epperla, Narendranath
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Marshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USAMarshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USA
Epperla, Narendranath
Bapani, Sowjanya
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Marshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USAMarshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USA
Bapani, Sowjanya
Garcia-Montilla, Romel
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Marshfield Clin Fdn Med Res & Educ, Dept Hosp Med, Marshfield, WI 54449 USAMarshfield Clin Fdn Med Res & Educ, Dept Internal Med, Marshfield, WI 54449 USA