A case of coronary thrombosis with temporary complete heart block

Department A CASE

of Clinical

OF CORONARY THROMBOXIS WITH COMPLETE HEBRT BLOCK* OLGA

TEMPORARY

M.D.

5% HANSEN,

MINNEAPOLIS,

I

Reports

MINN.

N ORDER to a,dd to the records of disturbances nary thrombosis the following case is reported.

of rhythm

in coro-

A male laborer, aged seventy-seven years, with a history of angina1 attaeks for at least nine years, developed an attack of severe substernal pain after lifting a heavy weight. Pallor, fever, leueocytosis and fall in blood pressure’ led to a diagnosis of coronary thrombosis. A systolic murmur, not present on examinations prior to this illness, appeared and increased in loudness and roughness over the lower precordium and was assoeiated with a prolonged systolic thrill just within the apex. The,se findings developed to a maximum by the fifth day and persisted until death which occurred suddenly on the twelfth day. Post-mortem examination was not permitted.

The electrocardiograms are of interest in that they show a complete dissociation between auricle and ventricle on the fifth and the, eighth day after the onset of the illness, but a normal auriculo-ventricular conduction time (.20 sec.) on the twelfth day shortly before his death. One can surmise the presence of a. thrombus extending into the ventricular cavity in such a way as to cause a systolic murmur and thrill, and an involvement of the auriculo-ventricular bundle by an area of transient tissue’ pathology which developed on the fifth day to a point of blocking impulses, and had aga,in returned to approximately normal function by the ninth day (clinical return to normal pulse rate), proved by electrocardiograms on the twelfth day. The case is presented because of two points of interest: 1. A rough murmur and thrill developed over the precordium in the early days following a case of coronary thrombosis, 2. Complete heart block developed on the fifth day and disappeared on the ni.nth, although the patient died suddenly on the twelfth day.

*From

tBe Department

of Medicine,

The Nicollet 386

Clinic.

HANSEN

:

CORONARJ CORONARY

THROMBOSIS

WITE

Fig. 1.--L NOV. 19, 1930 (fifth day of illness). complete dissociation. B. Nov. 22, 1930 (eighth block with missed beats. C. Nov. 26, 1930 (twelfth conduction P. R. = .20 sec.

COMPLETE

HEART

BLOCK.

Auricular rate 100, ventricular day). Partial auriculo-ventricular day). Normal auriculo-ventricular

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