High-grade AV block as presentation of non-ST segment elevation myocardial infarction by circumflex artery occlusion

Abstract

Atrioventricular Block is usually a frequent complication in the context of acute inferior myocardial infarction with ST elevation; however, the presentation of asymptomatic patients with a new 2:1 AVB as a manifestation of acute inferior infarction without ST elevation is extremely rare. Male, 53-year-old patient, with history of normal echocardiography and coronary angiography who was admitted due to 2:1 AVB and heart failure, without angina, with lateral hypokinesia on echocardiography and elevated troponins. Acute occlusion of the circumflex artery became manifest; therefore, angioplasty was performed on said artery with reversal within 48 hours of atrioventricular block. High-grade AV block in the setting of ACS is caused by the circumflex artery in only 5% of cases.
We have not found a bibliography of patients who present without angina. Ultrasensitive Troponin T is the best tool to identify them early and thus provide them with an effective treatment.