Consecutive electrocardiographic changes during percutaneous coronary intervention for acute coronary syndrome with high-grade atrioventricular block: a case report

BMC Cardiovascular Disorders

Masahiro Yoshinaga¹  Yu Mukai¹  Yumie Matsui¹  Masahiro Karakawa¹  Kotaro Yutaka¹  Hiroyuki Sueyoshi¹  Yohei Oishi¹  Yuzo Akita¹  Yasukiyo Mori²  Tomoko Hagino² 

[1] Division of Cardiology, Osaka Saiseikai Izuo Hospital;Division of Nephrology, Osaka Saiseikai Izuo Hospital;

关键词: Ischemic heart disease;    Acute coronary syndrome;    High-grade atrioventricular block;    Complete atrioventricular block;    Percutaneous coronary intervention;   

DOI  :  10.1186/s12872-020-01392-6

来源: DOAJ

【 摘 要 】

Abstract Background Acute coronary syndrome (ACS) with high-grade atrioventricular block (HAVB) still has a poor mortality risk, even in the current percutaneous coronary intervention (PCI) era. However, early PCI for ACS with HAVB is associated with improved in-hospital survival and a 6-month survival similar to that of ACS without HAVB. Case presentation A 70-year-old man was admitted to our hospital for ACS with HAVB. ECG showed complete AV block, complete right bundle branch block (CRBBB), and left axis deviation. Cardiac enzymes were elevated. He underwent temporary pacemaker insertion and coronary angiography, which showed severe stenosis of the proximal right coronary artery (RCA), 99% stenosis of the distal RCA with Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow, and total occlusion of the proximal left anterior descending artery (LAD). We performed primary PCI in both the RCA and LAD, which resulted in TIMI grade 3 flow in both. After PCI, the HAVB recovered to normal sinus rhythm with CRBBB; a normal QRS interval returned within three days. The patient was discharged from the hospital without complications. Conclusion In this case of ACS with HAVB, early intensive coronary artery reperfusion resulted in long-term patient survival. The blood supply to the AV node and bilateral bundle branches is complex. Multivessel ischemia may compromise both primary and collateral blood flows to the AV node and septum, resulting in severe conduction impairment. Clinicians performing PCI should be aware of this anatomy and physiology.

【 授权许可】

Unknown