A 68-year-old man with a history of diabetes mellitus type II, hypertension and active smoking was transferred to our hospital from a nearby hospital for coronary artery bypass graft (CABG) surgery after suffering a complicated inferior wall myocardial infarction (IWMI). Post the initial angioplasty, the patient developed in-stent thrombosis and became hypotensive with a systolic blood pressure < 90 mmHg. After hemodynamic stability was achieved he was transferred to our hospital. During his stay, the cardiac monitor showed fluctuations in his blood pressure with a drop in systolic blood pressure by 10 to 15 mmHg and diastolic blood pressure by 10 mmHg when he developed atrioventricular (AV) dissociation during an idioventricular rhythm. Atrial kick, the fourth phase of ventricular diastole in the cardiac cycle is where the atria contributes to the ventricular end diastolic volume by atrial contraction. The significance of the atrial kick in the hemodynamics of the patient was captured on the cardiac monitor during the patient's stay in the cardiac intensive care unit.

Surface ECG findings of abnormal atrial activity in ex-ELBW may explain their previously reported predisposition to developing AF.

No abstract

A 61-year-old man with a personal history of smoking and a family history of coronary artery disease presented with what he described as a squeezing pain in the left side of his chest that woke him from sleep. He also had associated dizziness and diaphoresis. His heart rate was 85 beats per minute, and he was hypotensive (blood pressure, 90/60 mm Hg). An initial electrocardiogram (ECG) showed a normal sinus rhythm, with ST-segment elevation in leads II, III, aVF, and V 1 (Panel A). Right ventricular infarction was suspected because of ST-segment elevation in V 1 . ECG with precordial leads on the right side was performed and showed 2:1 atrioventricular block and ST-segment elevation in leads rV 3 through rV 6 , which confirmed ST-segment elevation myocardial infarction of the inferior wall, with involvement of the right ventricle (Panel B). Intravenous fluids were administered, and a temporary transvenous pacing wire was placed. Coronary angiography revealed a right coronary artery with 100% occlusion proximal to the right ventricular branch (Panel C, arrow). Percutaneous coronary intervention was performed, and flow to the right coronary artery (Panel D, black arrow) and the right ventricular branch (Panel D, white arrow) was restored. With adequate fluid resuscitation and the restoration of flow in the blocked artery, the patient's hemodynamic status improved, and the temporary pacing wire was removed the next day. Subsequent echocardiography revealed normal left ventricular systolic function and mild right ventricular dysfunction.