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Year : 2019  |  Volume : 7  |  Issue : 3  |  Page : 97-104

Biventricular dysfunction and angiographic correlates of inferior wall myocardial infarction with high degree AV blocks

1 Department of Cardiology, ASRAM Medical College, Eluru, Andhra Pradesh, India
2 Department of General Medicine, ASRAM Medical College, Eluru, Andhra Pradesh, India

Correspondence Address:
Dr. Tammiraju Iragavarapu
Department of Cardiology, ASRAM Medical College, Eluru, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/heartindia.heartindia_18_19

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Objectives: Inferior wall myocardial infarction (IWMI) accounts for about 50% of acute myocardial infarction (MI) which are caused predominantly by occlusion of the right coronary artery which also mostly supplies both the SinoAtrial and atrioventricular (AV) nodes. The objective of this study is to analyze the incidence of high-degree AV blocks in IWMI with respect to right ventricular (RV) MI, RV dysfunction, left ventricular (LV) dysfunction, and their angiographic correlation. Methods: This study was a hospital-based retrospective cross-sectional analytical study involving 150 patients presenting to our casualty with Acute IWMI during August 2016–February 2018. We have collected the demographic details of these patients and analyzed various complications pertaining to AV Blocks. The patients were categorized into two groups – Group 1-IWMI with high-degree AV blocks and Group 2-IWMI without AV blocks. In-depth history and other details such as electrocardiogram, ventricular dysfunction by echocardiogram and angiographic data were analyzed among these two groups. Results: Among 150 patients with acute IWMI, high-degree AV blocks were seen in 35 patients (23%). The mean age of presentation was 56–65 years (31.4%) with male preponderance (60%). Severe LV dysfunction (ejection fraction <30%) in Group 1 (60%) was statistically significant with P < 0.00001 when compared to Group 2 (17.3%). RV dysfunction (tricuspid annular plane systolic excursion <16 mm) is seen in 57.2% versus 4.3% cases in Group 1 which is statistically significant with P < 0.00001. The triple vessel disease was significant in Group 1 (57.1% vs. 17.3%) whereas single-vessel disease (8.5% vs. 43.5%) was significant in Group 2 with P < 0.00001. Reversal of AV block is seen in 94.2% of cases after recanalization of RCA. Mortality was more in Group 1 (5.8% vs. 2.6%). Conclusion: IWMI with high-degree AV block has a worse prognosis with increased incidence of RV and LV dysfunction and multivessel disease. Prompt intervention can reverse AV block in most of the cases.

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