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Hypotension and Left Bundle Branch Block

Mazen M Kawji1, David Luke Glancy2

  • 1Heartland Cardiovascular Center, Joliet, Illinois.

The American Journal of Cardiology
|March 5, 2017
PubMed

Insights

This case study highlights acute inferior myocardial infarction in a patient with chronic kidney disease presenting with new hypotension. Prompt diagnosis and multi-vessel revascularization were crucial for management.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease.
  • Myocardial infarction (MI) can present atypically in patients with comorbidities like CKD.
  • Hypotension can be a presenting symptom of acute coronary syndromes.

Observation:

  • A 69-year-old male with CKD presented with new-onset hypotension.
  • Electrocardiogram (ECG) showed left bundle branch block and inferior ST-segment elevation, indicative of acute inferior MI.
  • Coronary arteriography revealed triple vessel disease with complete occlusion of the right coronary artery.

Findings:

  • The patient was diagnosed with acute inferior myocardial infarction.
  • The diagnostic pattern on ECG included concordant ST-segment elevation in leads II and aVF.
  • Significant triple vessel disease was identified as the underlying coronary pathology.

Implications:

  • This case underscores the importance of considering MI in CKD patients with atypical presentations like hypotension.
  • Early diagnosis using ECG and coronary angiography is vital for identifying complex coronary artery disease.
  • A multi-modal treatment approach, including mechanical circulatory support and revascularization, can be effective in managing high-risk MI patients.

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