Document Detail

ST-Elevation Myocardial Infarction in the Presence of Biventricular Paced Rhythm.
MedLine Citation:
PMID:  23769390     Owner:  NLM     Status:  Publisher    
BACKGROUND: In the diagnosis of acute myocardial infarction (AMI), the presence of baseline left bundle branch block or a permanent pacemaker rhythm poses a challenge. OBJECTIVE: We present a case report highlighting this challenge, along with a review of pertinent literature. CASE REPORT: A 70-year-old female with known severe idiopathic dilated cardiomyopathy and moderate coronary artery disease who was status post-biventricular pacemaker/implantable cardioverter defibrillator insertion was brought to our institution via Emergency Medical Services with recurrent firing of her implantable cardioverter defibrillator and syncope. After stabilization in the Emergency Department and treatment with intravenous amiodarone, the patient admitted to having ongoing chest pains. The electrocardiogram revealed evidence of biventricular pacing with superimposed ST-segment elevations in the anterolateral leads indicative of myocardial injury. She underwent prompt angiography, thrombectomy, and bare-metal stent insertion to a totally occluded proximal left anterior descending coronary artery, with resolution of her chest pain and improvement in the ST-segment changes. CONCLUSIONS: Despite proposed criteria that aid in the recognition of AMI with underlying left bundle branch block and paced rhythm; the advent of new pacing modalities and the potential variability of pacing sites impose additional diagnostic challenges requiring higher level of suspicion and better physician awareness.
Keerthana Karumbaiah; Bassam Omar
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-12
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  -     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Division of Cardiology, University of South Alabama Medical Center, Mobile, Alabama.
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