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Severe myocardial ischemia in a patient with diabetes mellitus and left bundle branch block

Brittain Heindl1, Ami E Iskandrian2, Fadi G Hage2,3

  • 1Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA. bfheindl@uabmc.edu.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|July 17, 2019
PubMed

Insights

A patient with diabetes, obesity, and heart block developed cardiogenic shock awaiting surgery. This case highlights risks in patients with multivessel coronary artery disease and conduction issues.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • A 69-year-old woman with diabetes mellitus, left bundle branch block, and obesity underwent cardiac procedures.
  • She developed cardiogenic shock after myocardial perfusion imaging and left heart catheterization, preceding coronary revascularization.

Observation:

  • The patient had pre-existing conditions including diabetes mellitus, left bundle branch block, and obesity.
  • She experienced cardiac decompensation and cardiogenic shock post-procedure but pre-revascularization.

Findings:

  • Multivessel coronary artery disease poses a risk of cardiac decompensation in patients awaiting surgical intervention.
  • Diabetes mellitus and left bundle branch block present imaging challenges and increase the risk of complete heart block during ischemia.

Implications:

  • This case underscores the critical need for timely intervention in patients with complex coronary artery disease and conduction abnormalities.
  • Careful consideration of underlying conditions is essential for safe cardiac imaging and management in high-risk patients.
  • Recognizing the risk of complete heart block in ischemic events is crucial for patients with pre-existing conduction disease.

Keywords:
DiabetesSPECTcardiogenic shockobesityperfusion imaging

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