A 44-year-old man presented to our emergency room with a history of chest tightness, vertigo and nausea as well as episodes of syncope. Physical examination revealed severe bradycardia of 30 bpm, blood pressure of 98/60 mmHg and the electrocardiographic monitor showed complete atrioventricular block (Figure, panel A). There was no history of chest trauma, fever or exposure to sexually transmitted diseases and he did not have a marfanoid appearance. Complete hemogram and biochemical parameters were within normal limits.