Atrioventricular conduction disturbances in a young patient with Fabryʹs disease without other signs of cardiac involvement

A 30 year-old male patient with a history of Fabryʹs disease, was referred to hospital with symptoms of dizziness, hypotension and weakness. Fabryʹs disease had beeb diagnosed 2 years before, based on angiokeratoma and hypohidrosis on physical examination and complete lack of alpha-galactosidase A on laboratory examination. The ECG on admission demonstrated sinus bradycardia, with a poor response to atropine administration. Echocardiograms on admission and 2 years before were normal, as well as Holter ambulatory ECG recording. Subsequent electrophysiological study demonstrated mild AV conduction disturbances at a site proximal to His, and the patient was simply advised to be regularly followed up. It can therefore be concluded that even young patients with Fabryʹs disease and normal echocardiograms might develop cardiac symptoms due to AV conduction abnormalities.