Question

Problem 1. A 62-year-old patient K. experienced myocardial infarction in the posterosuperior area of the left ventricle and interventricular septum 5 days ago. Suddenly, he felt weakness, dizziness, nausea, turned pale, and lost consciousness. ECG shows regular atrial waves at rates of 109 per min, and regular ventricular rhythm with a frequency of 42 per min; there is no association between P wave and QRS complexes; systemic blood pressure is 65/50 mm Hg. Define the form of cardiac pathology developed in the patient? Substantiate your answer using the clinical data and ECG. What electrophysiologic mechanism underlies this form of pathology? What metabolic changes and in what area of the heart engender the electrophysiologic disturbances developed in the patient? Substantiate your answer. Describe the principles of adequate treatment in this case.

Answer 1

1. This patient has developed Complete Heart block (3rd degree heart block).

In this there is complete dissociation of atrial and ventricular rhythm.

2. As ECG shows regular atrial rate is 109 and regular ventriular ventricular rate is 42. Rhythm is regular in both atria and Ventricle but both are dissociate completly from each other.

3. Myocardial Infarction of posterio superior area and Intervetricular septum may have lead to infarction of area of AV node and hence AV node is not conducting any signals to Ventricle.

4. For treatment of 3rd degree heart block Transcuaneous Ventricular pacemaker is needed.