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What lies beneath: Posterior ST elevation myocardial infarction with underlying right ventricular-paced rhythm

Alyssa Camille Browning1, Saul Schaefer

  • 1Division of Cardiovascular Medicine, University of California, Davis, Davis, California, USA.

Experimental and Clinical Cardiology
|December 3, 2013
PubMed

Insights

This case report highlights diagnosing myocardial infarction in patients with pacemakers. Prompt electrocardiogram review is crucial for detecting acute coronary syndrome in paced rhythms.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • A 66-year-old male with significant comorbidities including coronary artery disease, stage V chronic kidney disease, and peripheral arterial disease presented with chest and shoulder discomfort.
  • The patient had a history of a dual-chamber pacemaker and recently discontinued clopidogrel due to upcoming vascular surgery.

Observation:

  • The patient experienced persistent discomfort following hemodialysis.
  • Electrocardiography showed a right ventricular-paced rhythm with ST abnormalities suggestive of posterior ST elevation myocardial infarction.

Findings:

  • Urgent cardiac catheterization revealed an acutely occluded coronary artery requiring percutaneous coronary intervention.
  • Characteristic electrocardiographic abnormalities can predict acute myocardial infarction in patients with ventricular-paced rhythms.

Implications:

  • This case underscores the critical need for meticulous electrocardiogram interpretation in patients presenting with symptoms of acute coronary syndrome, especially those with ventricular-paced rhythms.
  • Timely diagnosis and intervention are vital for managing myocardial infarction in this complex patient population.

Keywords:
Acute myocardial infarctionDiagnosis of STEMIRight ventricular pacing

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