A 67-year-old male had sudden dizziness with bradycardia (HR 40-45/min) and hypotension (systolic 40-50mmHg). ECG revealed ST elevations in leads II, III and a Vf with an increase in PR interval (240ms). Angio revealed no significant blockade on right side, and 40-50% block of LAD. Echo showed dilated RV with moderate TR, but these findings normalized in the follow up echo done just an hour later. There was no infarcted area evidenced on echo later on.
ST elevation settled significantly within a few hours and the PR came to 200. But, HR still hovered around 40, while BP increased to 90 systolic on noradrenaline post procedure. Replacement by Dopamine finally brought up the HR over a few more hours. Trop I was marginally eleveated at 24 hours while CPK MB was negative. He has no cardiac risk factor except a mild isolated LDL increase of upto 125 for a few years, and is physically very…
