A case of total atrioventricular (AV) block with acute coronary syndrome at a Negara tertiary care hospital: a diagnostic and therapeutic challenge in a resource-limited setting

Abstract

Background: Total atrioventricular (AV) block describes a conduction disturbance from the atria to the ventricles via conduction through the atrioventricular node (AV node), acute coronary syndromes of mechanism, and being to cause mortality.Case Illustration: A 57-year-old man came with complaints of weakness two months ago, worsening for the last one week accompanied by left side chest pain. The patient is an active smoker without a history of chronic disease. ECG shows a total AV block with a junctional escape rhythm. Patients were treated with 1x75mg clopidogrel therapy, 1 x 80 mg aspirin, 3 x 5 mg ISDN, 5 mg / kg BW / minute, dopamine drip and 1 x 25 mg spironolactone. After being treated for three days with an increase in the maximum dopamine dose, the patient still felt weakness and chest pain on the left side, so the patient was referred to a tertiary hospital for echocardiography and percutaneous coronary intervention (PCI). Conclusion: a total atrioventricular (AV) block after an acute MI is a rare case. Clinical suspicion and proper evaluation of patients is essential for an early diagnosis, referral, and timely definitive treatment, to decrease the morbidity and mortality associated with this disease. Successful reperfusion at AV node is beneficial to the conduction system.