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Case Report Detailing an Inferior Myocardial Infarction, Third-Degree Heart Block, and Cardiogenic Shock

Daniella James, Leslie London

    Journal of Emergency Nursing
    |June 12, 2021
    PubMed

    Insights

    Right coronary artery infarction can cause heart blocks and arrhythmias by affecting the sinoatrial and atrioventricular nodes. This case highlights successful emergency care for inferior myocardial infarction with third-degree heart block and cardiogenic shock.

    Area of Science:

    • Cardiology
    • Emergency Medicine
    • Clinical Case Report

    Background:

    • The right coronary artery (RCA) supplies the sinoatrial (SA) and atrioventricular (AV) nodes, crucial for cardiac conduction.
    • Infarction of the RCA can disrupt normal heart rhythm by impairing these nodes.
    • Inferior myocardial infarction (MI) is frequently associated with RCA occlusion.

    Observation:

    • A middle-aged male presented with symptoms of an inferior myocardial infarction.
    • The patient experienced a concurrent third-degree heart block and developed cardiogenic shock.
    • Prehospital and emergency department interventions were initiated promptly.

    Findings:

    • The inferior myocardial infarction was directly linked to the right coronary artery occlusion.
    • The compromised blood flow to the SA and AV nodes resulted in a complete heart block (third-degree).
    • Successful revascularization of the RCA led to the patient's recovery from cardiogenic shock.

    Implications:

    • This case underscores the importance of recognizing RCA occlusion in inferior MI, especially with conduction abnormalities.
    • Prompt diagnosis and intervention, including revascularization, are critical for managing cardiogenic shock in this context.
    • Emergency clinicians should be aware of the unique challenges in managing right ventricular involvement and third-degree heart block during acute coronary syndrome.

    Keywords:
    Emergency nursingHeart blockMyocardial infarctionPercutaneous coronary intervention

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