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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

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Consecutive electrocardiographic changes during percutaneous coronary intervention for acute coronary syndrome with

Hiroyuki Sueyoshi1, Yuzo Akita2, Yohei Oishi2

  • 1Division of Cardiology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan. men.tan.pin.0708@gmail.com.

BMC Cardiovascular Disorders
|February 26, 2020
PubMed

Insights

Early percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) with high-grade atrioventricular block (HAVB) improves survival. Prompt reperfusion of blocked arteries can restore heart rhythm and prevent long-term complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Acute coronary syndrome (ACS) with high-grade atrioventricular block (HAVB) presents a significant mortality risk.
  • Early percutaneous coronary intervention (PCI) in ACS with HAVB is linked to better in-hospital survival rates.
  • Survival at six months post-PCI for ACS with HAVB is comparable to ACS cases without HAVB.

Observation:

  • A 70-year-old male patient presented with ACS and HAVB, exhibiting complete AV block, complete right bundle branch block (CRBBB), and left axis deviation.
  • Coronary angiography revealed severe stenosis in the right coronary artery (RCA) and total occlusion of the proximal left anterior descending artery (LAD).
  • Following primary PCI of the RCA and LAD, TIMI grade 3 flow was restored, and the patient's HAVB resolved to normal sinus rhythm within three days.

Findings:

  • Early and intensive coronary artery reperfusion in ACS with HAVB leads to favorable long-term survival outcomes.
  • The complex blood supply to the AV node and bundle branches means multivessel ischemia can cause severe conduction impairment.
  • Successful PCI restored normal conduction, resolving the high-grade atrioventricular block.

Implications:

  • This case highlights the importance of prompt PCI in managing ACS with HAVB.
  • Understanding the intricate vascular anatomy supplying the conduction system is crucial for interventional cardiologists.
  • Timely reperfusion therapy can significantly improve outcomes for patients with complex coronary artery disease and conduction abnormalities.
Abstract

Keywords:
Acute coronary syndromeComplete atrioventricular blockHigh-grade atrioventricular blockIschemic heart diseasePercutaneous coronary intervention

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