Document Detail

Myocardial infarction--fusion or confusion?
MedLine Citation:
PMID:  19726827     Owner:  NLM     Status:  MEDLINE    
A patient with a dualchamber pacemaker with dynamic atrioventricular delay (AVD) experienced acute substernal chest pain. The rhythm strip in the ambulance showed intermittent ST elevation in the inferior leads. An emergent cardiac catheterization revealed nonobstructive coronary artery disease. Rate-responsive dual-chamber pacing with dynamic AVD was responsible for varying devvgrees of ventricular fusion due to competition with the patient's normal conduction. Intermittent ST elevation, evident only during ventricular fusion should have suggested secondary ventricular repolarization and not myocardial injury, but concomitant chest pain and inconspicuous bipolar pacing artifacts added to the confusion. Ventricular pacing may not only mask acute ST-T changes due to myocardial injury, but can also mimic acute myocardial infarction.
Sivakumar Ardhanari; Ashok J Shah; Ranjan K Thakur
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  21     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-03     Completed Date:  2010-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E164-5     Citation Subset:  IM    
Thoracic and Cardiovascular Institute, Sparrow Health System & Michigan State University, Lansing, MI 48910, USA.
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MeSH Terms
Chest Pain / diagnosis,  etiology
Diagnosis, Differential
Myocardial Infarction / complications,  diagnosis*,  physiopathology*
Pacemaker, Artificial* / adverse effects
Ventricular Dysfunction / physiopathology*

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