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Acute anterior STEMI complicated with transient intraventricular conduction disturbance

Dr. Raimundo Barbosa Barros
Dr. Raimundo Barbosa Barros
Brazil

Case presentation

A 58-year-old Caucasian man was admitted to our emergency department due to prolonged oppressive retrosternal chest pain for 3 hours associated with shortness of breath and cold diaphoresis.
He had several risk factors: hypertension, low-density lipoprotein cholesterol elevated levels, central obesity (waist circumference = 112 cm and body mass index (BMI) =34), diabetic intolerance, and addiction to tobacco.

On physical examination, the jugular veins were noted 3 cm above the clavicles with the patient in a 45° semirecumbent position.
Absence of hepatojugular reflux (the height of the neck veins increases only 2 cm with moderate pressure applied over the middle of the abdomen for 30 seconds).

His blood pressure was 95/80 mm Hg (pulse pressure/systolic pressure ratio > 0.25) and alternating discrete irregular heart rate 107-111 bpm.
The point of maximal impulse was located in the midclavicular line at the left fifth intercostal space and it is covered by the tip of one index finger.

A third protodiastolic gallop or ventricular gallop (S3) was heard without murmurs with gallop cadence. Absence of rales in both pulmonary bases.
The liver edge was palpable smooth, uniform, non-tender and non painful at 1 cm of costal border. Absence of lower extremity edema.

The electrocardiograms are shown in the next slides.

Question

What are the diagnoses of both electrocardiograms?

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Auspicios Institucionales
  • Sociedad Argentina de Cardiología
  • Federación Argentina de Cardiología
  • SIAC
  • SADEC
  • Asociación Argentina de Cardiología
  • SOLAECE Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología
  • Fundación Barceló - Facultad de Medicina