September 18, 2015

AV block is more common in IWMI

Vignette: 65 yo with h/o  HTN, DM, dyslipidemia 
c/o of chest pain

Image 1

The rhythm is sinus tachycardia at about 107 bpm with complete heart block (CHB) with a junctional escape rhythm (50 bpm). There are ST elevations in II, III and aVF with ST depression more pronounced in aVL than I. ST-T wave changes can be seen in precordial leads extending to V4. This is inferior wall STEMI (IWMI)with  complete heart block. AV block is more common in IWMI because the AV node is  supplied by the right coronary artery (RCA).

Image 2

P waves are marked. Some of the P waves are (partly) hidden from view (blue arrowheads)

Echo showed EF between 45 - 50 %,with severe inferior and inferolateral  hypokinesis. Angiogram revealed lesion in the RCA and intervention was done.Patient was discharged a few days later in sinus rhythm (with no CHB). 


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