Inferior ST-Segment Elevation Myocardial Infarction with First-Degree Atrioventricular Block: A Case Report and Literature Review

Abstract

Background: Atrioventricular (AV) block complicating acute inferior wall ST-elevation myocardial infarction (STEMI) is known to be associated with poor outcomes and increased rate of mortality.

Case Report: We present the case of a 69-year old male patient, an active smoker, presented to the emergency department due to syncope 2 hours prior to admission. He reported symptoms while farming with sudden onset of diaphoresis, mild dizziness, and breathlessness followed by loss of consciousness for several minutes. Blood pressure was 79/55 mmHg, respiratory rate was 23, pulse was 46 bpm. Electrocardiogram showed inferior wall STEMI with first-degree AV block. Laboratory data revealed a significantly marked increase of CK-MB 82,5 U/L. STEMI protocol and fibrinolytic therapy has been done. The mechanisms of AV block and its spontaneous resolution in the setting of acute inferior wall STEMI are discussed. Attention is drawn to the patient due to our hospital categorized as an incapable cath lab sub-district hospital.

Discussion: Clinical signs and examination suggested that this patient had a first-degree AV block complicating inferior wall STEMI on admission and fulfill the criteria of successful reperfusion 30 minutes following fibrinolytic therapy. Immediately after fibrinolysis, breathlessness was relieved, ST-T segment was reduced, spontaneous resolution of first-degree AV block occurred, and absence of Q-wave formation.

Conclusion: Immediate reperfusion therapy is the core management of STEMI patients, including fibrinolytic therapy. Signs of successful therapy could be seen in this case and also relieved of the complication associated with STEMI. We found it as an incidence not much reported and thus reporting the case herewith.