Slow Regular Rhythm in a Disoriented Patient
| Autor: | Viral N. Lathia, Foster Mb, Manpreet Singh, Murtuza J. Ali, Glancy Dl, Alonso A |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
ST depression
medicine.medical_specialty business.industry Atrial fibrillation General Medicine medicine.disease QRS complex Internal medicine Right coronary artery medicine.artery cardiovascular system medicine Cardiology cardiovascular diseases Circumflex Myocardial infarction medicine.symptom business Atrioventricular block Stroke |
| Zdroj: | Baylor University Medical Center Proceedings. 28:83-84 |
| ISSN: | 1525-3252 0899-8280 |
| Popis: | A 65-year-old woman with a history of high blood pressure, diabetes mellitus, hyperlipidemia, chronic kidney disease, and stroke went to a walk-in clinic complaining of intermittent neck, left shoulder, and arm pain for several days. After being diagnosed with pneumonia and started on antibiotics, the patient went home. The pain became worse and constant 2 days later, and several hours thereafter her family found her disoriented and diaphoretic. An electrocardiogram on hospital admission showed atrial fibrillation, complete atrioventricular block, and a regular junctional escape rhythm at a rate of 37 beats/min (Figure). QRS, ST, and T changes indicated acute inferoposterolateral myocardial infarction, and the QT interval was long (604 msec; QTc 562). Figure. Electrocardiogram recorded on hospital admission. See text for explication. A survey of 11 studies of the culprit lesion sites in acute inferior myocardial infarction found right coronary artery to left circumflex coronary artery ratios that ranged from 2.2:1 to 7.0:1 with a mean of 4:1 (1). Furthermore, the artery to the AV node is a branch of the right 90% of the time and of the left circumflex only 10% of the time. Thus, there are good reasons for suspecting the right coronary artery as the culprit. Two findings, however, are common in left circumflex occlusions, but uncommon in right occlusions: ST depression in both leads V1 and V2 and ST depression ≥0.1 mV (1 mm) in lead aVR (1). Coronary arteriography, the ultimate clinical arbiter, demonstrated atherothrombotic occlusion in the middle portion of a dominant left circumflex coronary artery. This was treated with a bare metal stent, and a temporary transvenous electronic ventricular pacemaker increased the rate to 60 beats/min. Serum troponin I peaked at 75 ng/mL; reference |
| Databáze: | OpenAIRE |
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