Cardiogenic shock accompanied by dynamic left ventricular outflow tract obstruction and myocardial bridging after transient complete atrioventricular block mimicking ST-elevation myocardial infarction: a case report

BMC Research Notes

Sang Man Chung²  Hyun-Joong Kim²  Sung Hea Kim²  Jiwan Kim¹  Hyung Min Yu¹  Sanghee An¹  Seonghui Kang¹ 

[1] Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea;Department of cardiology, Konkuk University School of Medicine, Seoul, Korea

关键词: Complete AV block;    Myocardial bridge;    Transient MR;    Dynamic LVOT obstruction;    STEMI;   

Others  :  1140742
DOI  :  10.1186/1756-0500-6-478

 received in 2013-06-21, accepted in 2013-11-14,  发布年份 2013

【 摘 要 】

Background

Dynamic left ventricular outflow tract obstruction with or without mitral regurgitation is typically observed in hypertrophic cardiomyopathy, but is also occasionally seen without left ventricular hypertrophy. In this report, we present a case of cardiogenic shock that mimics ST-elevation myocardial infarction, due to dynamic left ventricular outflow tract obstruction with transient mitral regurgitation and myocardial bridging after transient complete atrioventricular block.

Case presentation

A 65-year-old man with hypertension presented himself at the emergency department with syncope after chest pain. His initial electrocardiography showed inferior ST elevation with profound precordial ST depression and transient complete atrioventricular block. Due to sustained hypotension, an intra-aortic balloon pump was applied. His coronary angiography revealed almost normal right coronary artery and left circumflex artery and only a severe myocardial bridge in the mid-segment of his left anterior descending artery. Instead, severe mitral regurgitation was found without regional wall motion abnormality both in the left ventriculography and the portable echocardiography. However the severe mitral regurgitation completely disappeared in follow up echocardiography the day after. The pressure gradient across the left ventricular outflow tract was measured at 8.95 mmHg during the resting state, and was increased to 38.95 mmHg during the Valsalva state.

Conclusions

The patient presented with a case of cardiogenic shock that mimicked ST-elevation myocardial infarction due to dynamic left ventricular outflow tract obstruction combined with myocardial bridging in the mid-left anterior descending artery.

【 授权许可】

   
2013 Kang et al.; licensee BioMed Central Ltd.

【 图 表 】

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