Blindness of the Heart: An Unusual Cause for Transient Bilateral Vision Loss

1Central Maine Medical Center, Lewiston, ME
2Central Maine Medical Center, Lewiston, ME

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 370

Case Presentation:

This is an 87‐year‐old who who complained of 8 brief episodes of transient bilateral vision loss lasting eight seconds each time for the past 2 days. Episodes were associated with dizziness and a grinding noise in both ears and occurred in the seated position. She denied loss of consciousness, weakness, numbness or tingling, chest pain, or shortness of breath. Her medical history was complicated by low back pain, bilateral hearing impairment with the use of hearing aids, coronary artery disease, diet controlled diabetes mellitus type 2, and hypothyroidism. Her physical exam on admission revealed normal vital signs with a heart rate of 69. Her eye exam was normal with reactive pupillary reflexes, no visual field defects, extraocular muscles intact, and normal fundoscopic exam with optic discs intact. Cardiovascular exam revealed a 2/6 systolic ejection murmur heard best at the right upper sternal border. Her neurologic exam showed intact cranial nerves with the exception of her vestibulocochlear nerve. Strength, sensation, and deep tendon reflexes were normal and symmetrical. Her laboratory studies, EKG, and CT head were within normal range. Initially, possible causes for this were considered to be vertebrobasilar ischemia, atypical migraines, seizures, and though rare, bilateral temporal arteritis. She was admitted to the telemetry unit, MRI/MRA brain was planned for the morning, and inflammatory markers were obtained. However, later that evening, she had another episode of transient bilateral vision loss accompanied by the grinding noise in her ears. At that time, the telemetry monitor revealed complete heart block with a 7.4‐second ventricular pause (see Fig. 1). Cardiology was consulted as pacemaker pads were placed on the patient. She initially received a temporary transvenous pacemaker and eventually had a dual chamber pacemaker placed the next morning. The patient's symptoms of transient bilateral vision loss and noise disturbance never returned.

Discussion:

Intrinsic AV nodal dysfunction resulting in complete heart block usually presents with dizziness, syncope, dyspnea, or angina. The symptom of transient bilateral vision loss is usually not a clinical manifestation of this disease based on our literature review. We postulated a combination of vertebrobasilar disease and cerebral hypoperfusion during the events as the etiology of her symptoms. Telemetry monitoring was the key to proper diagnosis for this patient given her atypical presentation. Paroxysmal complete heart block should be diagnosed appropriately and treated with dual chamber pacemaker.

Conclusions:

AV nodal dysfunction resulting in complete heart block should be added to the differential diagnosis of transient bilateral vision.

Paroxysmal complete heart block for a period of 7.4 seconds.

To cite this abstract:

Gummadi S, Geyer C. Blindness of the Heart: An Unusual Cause for Transient Bilateral Vision Loss. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 370. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/blindness-of-the-heart-an-unusual-cause-for-transient-bilateral-vision-loss/. Accessed July 21, 2019.

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