Symptomatic bradycardia and high degree AV block puts patients at high-risk for decompensation. While ischemia is a concern with all new conduction abnormalities. However it is a common development in patients with recent aortic valve replacement and often requires permanent pacemaker.
79-year-old women has severe aortic stenosis and 2-vessel coronary artery disease s/p coronary artery bypass graft who developed acute dyspnea. She was found to have chronic occlusion of her vein graft and acute thrombosis of her subclavian artery, causing diffuse cardiac ischemia and myonecrosis.