Aortic aneurysm with complete atrioventricular block and acute coronary syndrome

Purpose: The aim was to characterise acute coronary syndrome patients with complete atrioventricular block and to assess the effect on outcome. Methods: Patients admitted with acute coronary syndrome were divided according to the presence of complete atrioventricular block: group 1, with complete atrioventricular block; group 2, without complete atrioventricular block. Clinical, electrocardiographic and echocardiographic characteristics and prognosis during one year follow-up were compared between the groups. Results: Among 4799 acute coronary syndrome patients admitted during the study period, 91 (1.9%) presented with complete atrioventricular block. At presentation, group 1 patients presented with lower systolic blood pressure, higher Killip class and incidence of syncope. In group 1, 86.8% presented with ST-segment elevation myocardial infarction (STEMI), and inferior STEMI was verified in 79.1% of patients in group 1 compared with 21.9% in group 2 ( P<0.001). Right ventricular myocardial infarction was more frequent in group 1 (3.3% vs. 0.2%; P<0.001). Among patients who underwent fibrinolysis complete atrioventricular block was observed in 7.3% in contrast to 2.5% in patients submitted to primary percutaneous coronary intervention ( P<0.001). During hospitalisation group 1 had worse outcomes, with a higher incidence of cardiogenic shock (33.0% vs. 4.5%; P<0.001), ventricular arrhythmias (17.6% vs. 3.6%; P<0.001) and the need for invasive mechanical ventilation (25.3% vs. 5.1%; P<0.001). After a propensity score analysis, in a multivariate regression model, complete atrioventricular block was an independent predictor of hospital mortality (odds ratio 3.671; P=0.045). There was no significant difference in mortality at one-year follow-up between the study groups. Conclusion: Complete atrioventricular block conferred a worse outcome during hospitalisation, including a higher incidence of cardiogenic shock, ventricular arrhythmias and death.

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Transient complete atrioventricular block and ST-segment elevation induced by coronary vasospasm due to iatrogenic hyperkalemia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02644-x ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Miaomiao Cao ◽

Li Chen ◽

Chaofeng Sun ◽

Guoliang Li

Keyword(s):

Acute Coronary Syndrome ◽

Atrioventricular Block ◽

Periodic Paralysis ◽

Coronary Vasospasm ◽

Complete Atrioventricular Block ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Normal Urine ◽

Complete Atrioventricular

Abstract Background Hyperkalemia and acute coronary syndrome are not only all responsible for syncope related to complete atrioventricular block, but also share parts of electrocardiogram manifestations. Additionally, they influence each other. Case presentation A 32-year-old Chinese man presented with severe hypokalemia (1.63 mmol/l) at midnight in the emergency room. He developed unexpected rebound hyperkalemia (7.76 mmol/l) after 18 hours of oral and intravenous potassium chloride supplementation at a concentration of about 10 g/day and a rate of 10 mmol/hour. Subsequently, the patient complained of chest discomfort and dyspnea, followed by syncope for several minutes, approximately 2 hours after potassium reduction treatment had been started. The instant electrocardiogram showed complete atrioventricular block and elevated ST segment in the inferolateral leads, which resolved 15 minutes later, before hyperkalemia was corrected. Combined with mild coronary stenosis and negative myocardial injury markers, transient complete atrioventricular block induced by coronary vasospasm due to iatrogenic hyperkalemia was diagnosed. Normal urine potassium excretion, acid–base state, and other examinations made the diagnosis of hypokalemic periodic paralysis possible. Conclusions Hyperkalemia may provoke acute coronary syndrome, and early coronary angiography is an effective strategy for identifying the direct cause of acute complete atrioventricular block.

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Coronary Sinus Pacing in Patients after Tricuspid Valve Surgery with Complete Atrioventricular Block

Cardiology and Cardiovascular Medicine ◽

10.26502/fccm.92920086 ◽

2019 ◽

Vol 03 (05) ◽

Author(s):

Anna Rydlewska ◽

Krzysztof Boczar ◽

Jacek Lelakowski

Keyword(s):

Atrioventricular Block ◽

Tricuspid Valve ◽

Coronary Sinus ◽

Valve Surgery ◽

Complete Atrioventricular Block ◽

Tricuspid Valve Surgery ◽

Complete Atrioventricular

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The Association Between Cardio-Ankle Vascular Index and Primary Idiopathic Complete Atrioventricular Block in an Elderly Population

Angiology ◽

10.1177/00033197211028780 ◽

2021 ◽

pp. 000331972110287

Author(s):

Turhan Turan ◽

Faruk Kara ◽

Selim Kul ◽

Muhammet Rasit Sayın ◽

Sinan Sahin ◽

...

Keyword(s):

Arterial Stiffness ◽

Atrioventricular Block ◽

Elderly Population ◽

Complete Atrioventricular Block ◽

Age Related ◽

And Gender ◽

The Relationship ◽

Block Frequency ◽

Complete Atrioventricular ◽

Relevant Factors

The most common cause of complete atrioventricular block (CAVB) is age-related fibrotic degeneration and is referred to as primary idiopathic complete atrioventricular block (iCAVB). This study aims to investigate the relationship between iCAVB and arterial stiffness using the cardio-ankle vascular index (CAVI). In this study, of 205 CAVB patients, 41 patients with iCAVB implanted with a dual-chamber permanent pacemaker and 40 age- and gender-matched controls were studied. Arterial stiffness was assessed by a VaSera VS-1000 CAVI instrument. The CAVI values of patients with iCAVB were significantly higher compared with the controls (9.63 ± 1.42 vs 8.57 ± 1.12, P < .001). Idiopathic complete atrioventricular block frequency was higher among patients with abnormal CAVI values than those with borderline and normal CAVI ( P = .04). In multivariate analysis, only CAVI was an independent predictor of iCAVB after adjusting for other relevant factors (odds ratio, 2.575; 95% CI [1.390-4.770]; P = .003). The present study demonstrated that CAVI, as a marker of arterial stiffness, was increased among elderly patients with iCAVB. Thus, we provide a possible additional mechanism linking easily measured CAVI with iCAVB.

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A Case Report of a Rare Heterozygous Variant in the Desmin Gene Associated with Hypertrophic Cardiomyopathy and Complete Atrioventricular Block

CJC Open ◽

10.1016/j.cjco.2021.05.003 ◽

2021 ◽

Author(s):

Hideharu Oka ◽

Kouichi Nakau ◽

Rina Imanishi ◽

Takuo Furukawa ◽

Yasuko Tanabe ◽

...

Keyword(s):

Case Report ◽

Hypertrophic Cardiomyopathy ◽

Atrioventricular Block ◽

Complete Atrioventricular Block ◽

Heterozygous Variant ◽

Complete Atrioventricular

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Pre‐implant global longitudinal strain as an early sign of pacing‐induced cardiomyopathy in patients with complete atrioventricular block

Echocardiography ◽

10.1111/echo.14942 ◽

2021 ◽

Author(s):

Jung Yeon Chin ◽

Ki‐Woon Kang ◽

Sang Hyun Park ◽

Yu Jeong Choi ◽

Kyung Tae Jung ◽

...

Keyword(s):

Atrioventricular Block ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Early Sign ◽

Complete Atrioventricular Block ◽

Complete Atrioventricular

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Dopamine and epinephrine for managing complete atrioventricular block due to nonreperfused acute inferior wall myocardial infarction in a rural hospital: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x21996113 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199611

Author(s):

Evelyne Sandjojo ◽

Vanessa AMC Jaury ◽

Yufi K Astari ◽

Mahendria Sukmana ◽

Rizky A Haeruman ◽

...

Keyword(s):

Myocardial Infarction ◽

Case Report ◽

Atrioventricular Block ◽

Pacemaker Implantation ◽

Uncontrolled Hypertension ◽

Definitive Treatment ◽

Inferior Wall ◽

Complete Atrioventricular Block ◽

History Of ◽

Complete Atrioventricular

Inferior wall myocardial infarction occurs in approximately 50% of all myocardial infarctions. The most common conduction disorder of this disease is complete atrioventricular block. Immediate attention must be given to the myocardial infarction patients with conduction block due to the increased mortality rate in these patients. Temporary pacemaker implantation and permanent pacemaker implantation are recommended in complete atrioventricular block cases that do not improve with reperfusion. In this case report, a 64-year-old-female patient came to the emergency department of a rural General Hospital with complaints of epigastric pain, dizziness, nausea, and vomiting for 2 days before admission. She had uncontrolled hypertension without a history of diabetes mellitus, dyslipidemia, smoking, or a family history of heart disease. The electrocardiogram displayed an acute inferior wall myocardial infarction and complete atrioventricular block with escape junctional rhythm with a heart rate of 17 bpm. She was diagnosed with nonreperfused inferior wall myocardial infarction and a complete atrioventricular block. She was successfully treated with only dopamine and epinephrine as the definitive treatment because the patient refused to be referred to a tertiary hospital for percutaneous coronary intervention and pacemaker implantation due to financial reasons. Dopamine and epinephrine may be considered for complete atrioventricular block if transfer to a higher level of care is not feasible and as bridge therapy while waiting for transfer.

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