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

Abstract

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.

Reversible total atrioventricular block in a very high-risk non-ST-elevation myocardial infarction (NSTEMI) during conservative treatment in a limited resource setting: a case report

“…14 Epinephrine is also preferred in a patient with a hypotensive state. 15 Hemodynamic improvement was achieved by our patient after up-titrating the epinephrine dose with close monitoring. In this case, the ECG was converted into a firstdegree AV block.…”

Comparison of efficacy of dopamine versus epinephrine infusion in fluid refractory septic shock in a tertiary care pediatric ICU.

“…Dopamine and epinephrine, both are capable of providing vasopressor and inotropic effects. 9 Vasopressors are the vasoactive drugs utilized as the 1 st line treatment in septic shock among neonates caused by a reduction in the systemic vascular resistance (SVR). 10,11 It has been recommended in the "Surviving Sepsis Campaign" guidelines 2012 that in fluidrefractory septic shock, the first-line vasoactive agent is dopamine.…”

“…This was a randomized controlled trial carried out at the PICU of Children's Hospital Multan, Pakistan from August 2022 to January 2023. A sample size of 156 (78 in each group) was calculated taking efficacy in the epinephrine group (P1) = 48.3%, 9 ii) efficacy in the dopamine group (P2) = 29.0%, 9 iii) power of study = 80%, and iv) significance level = 5%.…”