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Siamkouris D, Offers E, Schloesser M, Ilieski G, Tzikas S. Ischemia Possibly Associated with High Degree Atrioventricular Block. Case Rep Cardiol 2023; 2023:6676757. [PMID: 37637853 PMCID: PMC10460276 DOI: 10.1155/2023/6676757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023] Open
Abstract
Conduction restoration in second- and third-degree atrioventricular (AV) block after revascularization in acute coronary syndrome (ACS) setting is well established, however this is not the case in non-ACS setting. We present a case of a patient referred for permanent pacemaker implantation, due to high degree AV block (HAVB), who restored his conduction possibly due to targeted revascularization. Thus, this case sheds insight in the reversibility potential of HAVB after revascularization in non-ACS patients, which although signified in current literature, is still far from being a recommendation, due to lack of robust scientific confirmation.
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Affiliation(s)
- Dimitrios Siamkouris
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Elmar Offers
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Marc Schloesser
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Gjoko Ilieski
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sandjojo E, Jaury VA, Astari YK, Sukmana M, Haeruman RA, Kloping YP. Dopamine and epinephrine for managing complete atrioventricular block due to nonreperfused acute inferior wall myocardial infarction in a rural hospital: A case report. SAGE Open Med Case Rep 2021; 9:2050313X21996113. [PMID: 33796312 PMCID: PMC7970234 DOI: 10.1177/2050313x21996113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
Inferior wall myocardial infarction occurs in approximately 50% of all myocardial
infarctions. The most common conduction disorder of this disease is complete
atrioventricular block. Immediate attention must be given to the myocardial
infarction patients with conduction block due to the increased mortality rate in
these patients. Temporary pacemaker implantation and permanent pacemaker
implantation are recommended in complete atrioventricular block cases that do
not improve with reperfusion. In this case report, a 64-year-old-female patient
came to the emergency department of a rural General Hospital with complaints of
epigastric pain, dizziness, nausea, and vomiting for 2 days before admission.
She had uncontrolled hypertension without a history of diabetes mellitus,
dyslipidemia, smoking, or a family history of heart disease. The
electrocardiogram displayed an acute inferior wall myocardial infarction and
complete atrioventricular block with escape junctional rhythm with a heart rate
of 17 bpm. She was diagnosed with nonreperfused inferior wall myocardial
infarction and a complete atrioventricular block. She was successfully treated
with only dopamine and epinephrine as the definitive treatment because the
patient refused to be referred to a tertiary hospital for percutaneous coronary
intervention and pacemaker implantation due to financial reasons. Dopamine and
epinephrine may be considered for complete atrioventricular block if transfer to
a higher level of care is not feasible and as bridge therapy while waiting for
transfer.
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3
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Hossain N, Hossain N, Al-Sadawi M, Haq S. Bezold–Jarisch reflex-mediated asystole during dobutamine stress testing: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33532694 PMCID: PMC7837248 DOI: 10.1093/ehjcr/ytaa348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/21/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Background The Bezold–Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography. Case summary We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20 μg/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal. Discussion This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.
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Affiliation(s)
- Nimrah Hossain
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA
| | - Naseem Hossain
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Mohammed Al-Sadawi
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Salman Haq
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA
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Domico M, McCanta AC, Hunt JL, Ashouri N, Nugent D, Kelly RB. High-grade heart block requiring transvenous pacing associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic. HeartRhythm Case Rep 2020; 6:811-814. [PMID: 32864334 PMCID: PMC7446646 DOI: 10.1016/j.hrcr.2020.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Michele Domico
- Division of Critical Care, Cardiovascular Intensive Care Unit, Children's Hospital of Orange County, Orange, California.,University of California, Irvine, Irvine, California
| | - Anthony C McCanta
- University of California, Irvine, Irvine, California.,Division of Cardiology, Children's Hospital of Orange County, Orange, California
| | - Juliette L Hunt
- Division of Critical Care, Cardiovascular Intensive Care Unit, Children's Hospital of Orange County, Orange, California.,University of California, Irvine, Irvine, California
| | - Negar Ashouri
- University of California, Irvine, Irvine, California.,Division of Infectious Disease, Children's Hospital of Orange County, Orange, California
| | - Diane Nugent
- University of California, Irvine, Irvine, California.,Division of Hematology, Children's Hospital of Orange County, Orange, California
| | - Robert B Kelly
- Division of Critical Care, Cardiovascular Intensive Care Unit, Children's Hospital of Orange County, Orange, California.,University of California, Irvine, Irvine, California
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Patel R, Krukowski A, Sheikh A. High Degree Atrioventricular Block in Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) and Role of Early Revascularization. Cureus 2020; 12:e9222. [PMID: 32699725 PMCID: PMC7370675 DOI: 10.7759/cureus.9222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
High degree atrioventricular block (HDAVB) is a rare complication of non-ST-elevation myocardial infarction (NSTEMI) and often requires pacemaker implantation. We describe a case of reversal of HDAVB in a patient with dual atrioventricular node blood supply following coronary revascularization and potential mechanisms of such complications.
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Nemeth A, Salewski C, Krüger T, Lausberg HF, Schlensak C, Popov AF. Elektrophysiologie und Rhythmustherapie in der postoperativen herzchirurgischen Phase. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-019-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Geraiely B, Saadat M, Afarideh M. Clinical utility of percutaneous coronary intervention on left anterior descending stenosis in the setting of third-degree atrioventricular block due to inferior myocardial infarction: a case report. Eur Heart J Case Rep 2018; 2:ytx022. [PMID: 31020079 PMCID: PMC6426079 DOI: 10.1093/ehjcr/ytx022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/31/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Babak Geraiely
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadat
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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