Exercise Stress Test–Induced Atrioventricular Dissociation With Syncope

Background: The exercise stress test is widely used as a diagnostic test for evaluating coronary artery disease in symptomatic patients or those with underlying cardiovascular disorders. Although exercise stress test risk is minimal with a <1% chance of causing heart block, physician awareness of potential complications is paramount for prompt recognition and treatment. Case Report: A 65-year-old-female with angina-like chest pain underwent an exercise stress test for ischemic heart disease evaluation. She performed the exercise stress test up to stage 2 (exercise Bruce protocol) with an exercise duration of 5 minutes and maximum metabolic equivalents of 7. During her recovery phase, the patient developed atrioventricular dissociation with junctional rhythm followed by syncope. Immediate treatment was administered, including intravenous normal saline, and she recovered without any complications. Conclusion: This case reminds clinicians to be aware of the unpredictable effects of the exercise stress test even though atrioventricular dissociation after an exercise stress test is rare. Providing immediate treatment to prevent any untoward effects is essential.