Acute myocardial infarction and heart block: a challenge to emergency physicians.
We present the case of a patient who underwent an acute ST-elevation myocardial infarction of the inferior wall and transitory total heart block in the first hours of his clinical presentation. There was no haemodynamic instability before the thrombolytic therapy was performed 8 h after the onset of pain. There was no block recurrence. The current case shows a possible complication during the thrombolytic therapy and the urge for a quick decision by the emergency physician. Pacemaker implantation should be considered in the event of the patient's haemodynamic worsening once the success of the therapy is a reflex of the arrhythmia reversion most of the times.
Department of General Practice, Faculdade de Medicina do ABC, Santo André, Brazil. mrbacci@yahoo.com
Marcelo Rodrigues
MR
Bacci
Janaina Aparecida Boide
JA
Santos
Leonardo Fernando Ferrari
LF
Nogueira
José Jorge
JJ
Namura
D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004562:Electrocardiography; D017984:Enoxaparin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006327:Heart Block / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin