We present a case of a 75-year-old lady with effort intolerance and baseline ECG showing 2:1 atrioventricular block, in whom it was unclear as to
the requirement of permanent pacing, even after long term ECG monitoring. She underwent a treadmill test during which her QRS became wide
and developed complete heart block within 2 minutes of the test. Thus, a simple exercise test confirmed the level of the block to be infra nodal
without the need for the invasive study. In patients with exertional symptoms, even in elderly, and in those where ECG masquerades as a benign
entity, exercise testing is useful to differentiate benign cases of atrioventricular block from the more serious cases that mandate pacemaker
Keywords: Atrioventricular block, Complete heart block, Exercise test, Intra-Hisian block, Infra nodal, Coronary angiogram.
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