Isolated Obtuse Marginal Branch Occlusion Presenting as Recurrent Sinus Arrest without ST-segment Elevation

Abstract

A 47-year-old man presented with dyspnea and presyncope. Initial electrocardiography showed sinus bradycardia without ST-segment elevation, whereas telemetry revealed recurrent sinus arrest with a maximum pause of 3.3 s. Emergency coronary angiography revealed total occlusion of the obtuse marginal branch. Although the sinoatrial node artery originated near the occlusion, intravascular ultrasound confirmed the preservation of blood flow. Immediate revascularization led to complete resolution of sinus arrest. This case suggests that isolated lateral wall ischemia may represent an unusual manifestation of the Bezold-Jarisch reflex without direct sinoatrial node artery involvement. Therefore, acute coronary syndrome should be considered in unexplained sinus node dysfunction, even in the absence of typical chest pain.

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Cite

BibTeX RIS

BibTeX

@article{tanaka2026isolated,
  title = {{Isolated Obtuse Marginal Branch Occlusion Presenting as Recurrent Sinus Arrest without ST-segment Elevation}},
  author = {Ryo Tanaka},
  journal = {Internal Medicine},
  year = {2026},
  month = oct,
  doi = {10.2169/internalmedicine.7888-26},
  url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7888-26/_article},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Isolated Obtuse Marginal Branch Occlusion Presenting as Recurrent Sinus Arrest without ST-segment Elevation
AU  - Ryo Tanaka
PY  - 2026
DA  - 2026/10/29
JO  - Internal Medicine
DO  - 10.2169/internalmedicine.7888-26
UR  - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7888-26/_article
AB  - A 47-year-old man presented with dyspnea and presyncope. Initial electrocardiography showed sinus bradycardia without ST-segment elevation, whereas telemetry revealed recurrent sinus arrest with a maximum pause of 3.3 s. Emergency coronary angiography revealed total occlusion of the obtuse marginal branch. Although the sinoatrial node artery originated near the occlusion, intravascular ultrasound confirmed the preservation of blood flow. Immediate revascularization led to complete resolution of sinus arrest. This case suggests that isolated lateral wall ischemia may represent an unusual manifestation of the Bezold-Jarisch reflex without direct sinoatrial node artery involvement. Therefore, acute coronary syndrome should be considered in unexplained sinus node dysfunction, even in the absence of typical chest pain.
SN  - 1349-7235
SN  - 0918-2918
ER  -

Abstract

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