Inferior ST-elevation myocardial infarction managed with a pharmacoinvasive strategy and conservative management of delayed atrioventricular block: classical case report

Abstract

Background The 2017 ESC guideline on patients with ST-segment elevation myocardial infarction (STEMI) provides guidance regarding the optimal management of these patients. Transient atrioventricular (AV) block is a relatively common complication of inferior STEMI and its management is also addressed in the guidelines. Case summary A 64-year-old gentleman with multiple cardiovascular risk factors presented to the emergency department with a history of ischaemic type chest pain and evidence of inferior ST-segment elevation on his electrocardiogram (ECG). First-degree AV block was noted on his initial ECG. He was given thrombolytic therapy as part of a pharmacoinvasive strategy of reperfusion. He, however, failed fibrinolytic therapy, and emergency angiography revealed critical disease of the right coronary artery which was successfully stented. Subsequent to reperfusion, he developed complete AV block without evidence of re-infarction, which was managed conservatively with successful resolution of the block after 7 days of expectant management with temporary transvenous pacing. Discussion We highlight some of the important management principles from the ESC guideline of STEMI including timing and the management of AV block in these patients. In addition, we highlight the role of a pharmacoinvasive strategy for reperfusion where timeous primary percutaneous coronary intervention cannot be performed. The usefulness of such a strategy within the COVID-19 era is also emphasized.

Heart Block in the Patients with COVID-19

“…Pecora et al described a patient with left posterior hemiblock and high-grade AV block, which resolved with implantation of a temporary pacemaker 36 . 2 patients developed Mobitz type 2 heart block, which was followed by 3rd-degree complete heart block 13,41 . Azakirsh et al illustrated a patient who developed Mobitz type 2 AV block (2:1) with intermittent LBBB on the 3rd day of hospitalization; this evolved on the fourth day to Mobitz type 2 AV block (2:1) with fixed LBBB, and on the sixth day to AF with bradycardia.…”