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Conduction disturbances and paroxysmal atrial fibrillation during acute inferior myocardial infarction
International Journal of Cardiology 129 (2008) e37 – e40 www.elsevier.com/locate/ijcard
Letter to the Editor
Conduction disturbances and paroxysmal atrial fibrillation during acute inferior myocardial infarction Salvatore Patanè a,⁎, Filippo Marte a , Gianluca Di Bella b , Amedeo Chiribiri c a
b
Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Italy Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy c Cardiologia Universitaria ASO San Giovanni Battista Molinette Torino, Italy Received 3 February 2007; accepted 25 April 2007 Available online 8 August 2007
Abstract Associated symptoms and conduction disturbances are reported during acute inferior myocardial infarction. Differentiation of right coronary artery from left circumflex artery occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction. Paroxysmal atrial fibrillation is considered a frequent complication of acute myocardial infarction and the patients with paroxysmal atrial fibrillation probably should be targeted for earlier and more aggressive treatment. These patients in the thrombolytic era have a better overall outcome than counterparts in the prethrombolytic era. We describe a case of conduction disturbances and paroxysmal atrial fibrillation in a 51-year-old Italian man with acute inferior myocardial infarction and right coronary artery stenosis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Conduction disturbances; Paroxysmal atrial fibrillation; Acute inferior myocardial infarction
1. Case report Associated symptoms [1] and conduction disturbances are reported during acute inferior myocardial infarction [2]. Differentiation of right coronary artery from left circumflex artery occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction [3,4]. Paroxysmal atrial fibrillation is considered a frequent complication of acute myocardial infarction [5] and the patients with paroxysmal atrial fibrillation probably should be targeted for earlier and more aggressive treatment. These
⁎ Corresponding author. Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy. Tel.: +39 3402783962. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.04.130
patients in the thrombolytic era have a better overall outcome than counterparts in the prethrombolytic era [6]. We describe a case of conduction disturbances and paroxysmal atrial fibrillation in a 51-year-old Italian man with acute inferior myocardial infarction and right coronary artery stenosis. On January 31st, 2007, at 08:15 p.m., a 42-year-old Italian man was admitted to the emergency department with chest pain. A history of nausea with weakness was present. A history of a transient syncope, just occurred at 08:00 p.m. and a history of chest pain occurred 2 weeks ago were present too. The patient was in treatment with aspirin 100 mg once a day and intermittent transdermal nitrates. Blood pressure values were 90/60 mm Hg, the heart rate was 49 beats/min, the oxygen saturation was normal. The ECG showed a third-degree atrioventricular block with ST-segment elevation in II III avF. (Fig. 1) The patient was treated with thrombolysis (bolus of tenecteplase),aspirin (500 mg), intravenous heparin (bolus of 5000 IU and 1000 IU/h as a maintenance), omeprazol, cortisone (double dose), atropine. After thrombolysis, aspirin, heparin and the first cortisone dose the symptoms
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S. Patanè et al. / International Journal of Cardiology 129 (2008) e37–e40
Fig. 1.
were headache with nausea with weakness and mental confusion. The monitor revealed a third-degree atrioventricular block with heart rate of 35 beats/min. Blood pressure
values were 80/60 mm Hg. The restoration of sinusal rhythm was observed at the monitor: it preceded vomit and atrial fibrillation. The ECG (Fig. 2) showed atrial fibrillation,
S. Patanè et al. / International Journal of Cardiology 129 (2008) e37–e40
e39
Fig. 2.
electrocardiographic signs of reperfusion, axis deviation and ST-segment depression in v3, v4, v5, v6. A left posterior fascicular block was present too. Intravenous amiodarone (bolus and maintenance) was added to the treatment. Blood pressure values were 120/70 mm Hg, the oxygen saturation was normal. Over the following hours the patient felt better. The restoration of sinusal rhythm was observed. Serum potassium levels were 3.6 mEq/l (normal value 3.6–5.2) and potassium repletion was added to the treatment. Coronary angiography revealed significant right coronary artery stenosis.
2. Methods The electrocardiographic images were obtained with a Cardioline Delta 1 Plus. References [1] Culic V, Miric D, Eterovic D. Correlation between symptomatology and site of acute myocardial infarction. Int J Cardiol Feb 2001;77(2–3):163–8. [2] Majumder AA, Malik A, Zafar A. Conduction disturbances in acute myocardial infarction: incidence, site-wise relationship and the
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S. Patanè et al. / International Journal of Cardiology 129 (2008) e37–e40
influence on in-hospital prognosis. Bangladesh Med Res Counc Bull Aug 1996;22(2):74–80. [3] Wong CK, Freedman SB. Electrocardiographic identification of the infarct-related artery in acute inferior myocardial infarction. Int J Cardiol Apr 19 1996;54(1):5–11. [4] Serrano Jr CV, Bortolotto LA, Cesar LA, et al. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction. Int J Cardiol Jan 1999;68(1):75–82.
[5] Asanin M, Perunicic J, Mrdovic I, et al. Significance of recurrences of new atrial fibrillation in acute myocardial infarction. Int J Cardiol May 10 2006;109(2):235–40 [Electronic publication 2005 Jul 11]. [6] Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation Mar 17 1998;97(10):965–70.
Letter to the Editor
Conduction disturbances and paroxysmal atrial fibrillation during acute inferior myocardial infarction Salvatore Patanè a,⁎, Filippo Marte a , Gianluca Di Bella b , Amedeo Chiribiri c a
b
Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Italy Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy c Cardiologia Universitaria ASO San Giovanni Battista Molinette Torino, Italy Received 3 February 2007; accepted 25 April 2007 Available online 8 August 2007
Abstract Associated symptoms and conduction disturbances are reported during acute inferior myocardial infarction. Differentiation of right coronary artery from left circumflex artery occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction. Paroxysmal atrial fibrillation is considered a frequent complication of acute myocardial infarction and the patients with paroxysmal atrial fibrillation probably should be targeted for earlier and more aggressive treatment. These patients in the thrombolytic era have a better overall outcome than counterparts in the prethrombolytic era. We describe a case of conduction disturbances and paroxysmal atrial fibrillation in a 51-year-old Italian man with acute inferior myocardial infarction and right coronary artery stenosis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Conduction disturbances; Paroxysmal atrial fibrillation; Acute inferior myocardial infarction
1. Case report Associated symptoms [1] and conduction disturbances are reported during acute inferior myocardial infarction [2]. Differentiation of right coronary artery from left circumflex artery occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction [3,4]. Paroxysmal atrial fibrillation is considered a frequent complication of acute myocardial infarction [5] and the patients with paroxysmal atrial fibrillation probably should be targeted for earlier and more aggressive treatment. These
⁎ Corresponding author. Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy. Tel.: +39 3402783962. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.04.130
patients in the thrombolytic era have a better overall outcome than counterparts in the prethrombolytic era [6]. We describe a case of conduction disturbances and paroxysmal atrial fibrillation in a 51-year-old Italian man with acute inferior myocardial infarction and right coronary artery stenosis. On January 31st, 2007, at 08:15 p.m., a 42-year-old Italian man was admitted to the emergency department with chest pain. A history of nausea with weakness was present. A history of a transient syncope, just occurred at 08:00 p.m. and a history of chest pain occurred 2 weeks ago were present too. The patient was in treatment with aspirin 100 mg once a day and intermittent transdermal nitrates. Blood pressure values were 90/60 mm Hg, the heart rate was 49 beats/min, the oxygen saturation was normal. The ECG showed a third-degree atrioventricular block with ST-segment elevation in II III avF. (Fig. 1) The patient was treated with thrombolysis (bolus of tenecteplase),aspirin (500 mg), intravenous heparin (bolus of 5000 IU and 1000 IU/h as a maintenance), omeprazol, cortisone (double dose), atropine. After thrombolysis, aspirin, heparin and the first cortisone dose the symptoms
e38
S. Patanè et al. / International Journal of Cardiology 129 (2008) e37–e40
Fig. 1.
were headache with nausea with weakness and mental confusion. The monitor revealed a third-degree atrioventricular block with heart rate of 35 beats/min. Blood pressure
values were 80/60 mm Hg. The restoration of sinusal rhythm was observed at the monitor: it preceded vomit and atrial fibrillation. The ECG (Fig. 2) showed atrial fibrillation,
S. Patanè et al. / International Journal of Cardiology 129 (2008) e37–e40
e39
Fig. 2.
electrocardiographic signs of reperfusion, axis deviation and ST-segment depression in v3, v4, v5, v6. A left posterior fascicular block was present too. Intravenous amiodarone (bolus and maintenance) was added to the treatment. Blood pressure values were 120/70 mm Hg, the oxygen saturation was normal. Over the following hours the patient felt better. The restoration of sinusal rhythm was observed. Serum potassium levels were 3.6 mEq/l (normal value 3.6–5.2) and potassium repletion was added to the treatment. Coronary angiography revealed significant right coronary artery stenosis.
2. Methods The electrocardiographic images were obtained with a Cardioline Delta 1 Plus. References [1] Culic V, Miric D, Eterovic D. Correlation between symptomatology and site of acute myocardial infarction. Int J Cardiol Feb 2001;77(2–3):163–8. [2] Majumder AA, Malik A, Zafar A. Conduction disturbances in acute myocardial infarction: incidence, site-wise relationship and the
e40
S. Patanè et al. / International Journal of Cardiology 129 (2008) e37–e40
influence on in-hospital prognosis. Bangladesh Med Res Counc Bull Aug 1996;22(2):74–80. [3] Wong CK, Freedman SB. Electrocardiographic identification of the infarct-related artery in acute inferior myocardial infarction. Int J Cardiol Apr 19 1996;54(1):5–11. [4] Serrano Jr CV, Bortolotto LA, Cesar LA, et al. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction. Int J Cardiol Jan 1999;68(1):75–82.
[5] Asanin M, Perunicic J, Mrdovic I, et al. Significance of recurrences of new atrial fibrillation in acute myocardial infarction. Int J Cardiol May 10 2006;109(2):235–40 [Electronic publication 2005 Jul 11]. [6] Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation Mar 17 1998;97(10):965–70.