1 Dr Mohammed Iqbal A N,2 Dr Deepak Kumar,3 Dr Divendu Bhushan, 4 Dr Vishal Vaibhaw
1 Junior Resident AIIMS Patna, India
2 Assistant Professor, Dept of Emergency Medicine, AIIMS Patna, India
3 Associate Professor & Head, Dept of Emergency Medicine, AIIMS Patna, India
4 Assistant Professor, Dept of Emergency Medicine, AIIMS Patna, India
ABSTRACT:
Myocardial infarction can present to the emergency room in the form of various complications. Anterior wall MI is notorious for producing mechanical complications like ventricular free wall rupture, ventricular septum rupture, and papillary muscle rupture. Inferior wall MI is usually associated with conduction abnormalities like heart blocks. Here, reperfusion of the myocardium and concurrent management of the complication should go hand in hand. We had a patient presenting to the ER with an ECG that was confusing between a PSVT and VT which when reverted revealed an anterior wall MI. The patient was salvaged with prompt revascularization.
KEYWORDS:
Myocardial Infarction, PSVT, Ventricular Tachycardia.
REFERENCES :
1) Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-64. doi: 10.1016/j.jacc.2018.08.1038.
2) Conduction abnormalities after myocardial infarction. UpToDate. Available from: https://www.uptodate.com/
3) Supraventricular Tachycardia (SVT) • LITFL • ECG Library Diagnosis [Internet]. Available from: https://litfl.com/supraventricular-tachycardia-svt-ecg-library/
4) Supraventricular Tachycardia. N Engl J Med.
5) Bhar-Amato J, Davies W, Agarwal S. Ventricular arrhythmia after acute myocardial infarction: ‘The perfect storm.’ Arrhythmia Electrophysiol Rev. 2017;6(3):134.
6) Go AS, Barron HV, Rundle AC, Ornato JP, Avins AL. Bundle-branch block and in-hospital mortality in acute myocardial infarction. Ann Intern Med. 1998;129(9):690-7. doi:10.7326/0003-4819-129-9-199811010-00003.
7) Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, Williams K, Ohman EM, Topol E, Califf RM. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J. 2005;149(4):670-4. doi: 10.1016/j.ahj.2004.07.035.
8) Crimm A, Severance HW Jr, Coffey K, McKinnis R, Wagner GS, Califf RM. Prognostic significance of isolated sinus tachycardia during the first three days of acute myocardial infarction. Am J Med. 1984;76(6):983-8. doi:10.1016/0002-9343(84)90846-5.
9) Bigger JT Jr, Dresdale FJ, Heissenbuttel RH, Weld FM, Wit AL. Ventricular arrhythmias in ischemic heart disease: mechanism, prevalence, significance, and management. Prog Cardiovasc Dis. 1977;19(4):255-300. doi:10.1016/0033-0620(77)90005-6.
10) O’Doherty M, Tayler DI, Quinn E, Vincent R, Chamberlain DA. Five hundred patients with myocardial infarction monitored within one hour of symptoms. Br Med J (Clin Res Ed). 1983;286(6375):1405-8. doi:10.1136/bmj.286.6375.1405.
11) Tran HV, Ash AS, Gore JM, Darling CE, Kiefe CI, Goldberg RJ. Twenty-five-year trends (1986-2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular fibrillation complicating acute myocardial infarction. Am Heart J. 2019; 208:1-10. doi: 10.1016/j.ahj.2018.10.007.
