Abstract
An 82-year-old woman with parkinsonism and Lewy body dementia was re-admitted to our
hospital due to convulsions and the recurrence of cerebral infarction. Parasternal
transthoracic echocardiography showed normal left ventricular wall thickness and wall
motion. To treat marked bradycardia and hypotension, she underwent temporary pacing.
However, she lost her consciousness, when her blood pressure could not be measured.
Simultaneous electrocardiogram and blood pressure monitoring showed that systolic
blood pressure decreased by almost 30 mmHg from sinus rhythm to junctional rhythm.
In the present case of acute cerebral infarction, severe hypotension occurred during
junctional rhythm possibly contributed by parkinsonism and Lewy body dementia.
Learning objective
As patients with junctional rhythm usually have no or mild symptoms, there are no
specific guidelines for its evaluation and treatment. However, severe symptoms such
as hypotension, cerebral infarction, loss of consciousness, or breathlessness may
occur in some cases. Holter electrocardiogram with 24-hour noninvasive blood pressure
monitoring may be helpful in such severe cases.
Keywords
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Article info
Publication history
Published online: October 28, 2022
Accepted:
October 12,
2022
Received in revised form:
October 6,
2022
Received:
September 1,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
