Publication: Reversing AV Block and Cardiogenic Shock in STEMI Care: A Case Report on Use of Fibrinolysis and Inotrope without PCI in Rural Nepal
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Atrioventricular block and cardiogenic shock are critical complications of inferior
wall myocardial infarction with high mortality, especially in resource-limited
settings lacking percutaneous coronary intervention. We report a 53-year-old male
smoker presenting to a rural hospital with acute chest pain, dyspnea, and profound
hemodynamic instability with electrocardiogram showing inferior wall ST-segment
elevation myocardial infarction with Mobitz type I atrioventricular block. This case
highlights reversal of atrioventricular block with return of hemodynamic stablility
using Streptokinase and ionotropes in a rural setting. Therefore, timely fibrinolysis
and inotropes in managing inferior wall myocardial infarction with atrioventricular
block and cardiogenic shock in percutaneous coronary intervention -inaccessible
regions and strengthening rural ST segment elevation myocardial infarction care
networks is crucial.
KEY WORDS
Atrioventricular block, Fibrinolysis, Percutaneous coronary intervention, Rural
health, Shock cardiogenic, ST elevation myocardial infarction
Description
Pradhan A, Tamrakar P, Bhandari J, Mahat P
Department of General Practice and Emergency Medicine
Karnali Academy of Health Sciences
Jumla, Karnali, Nepal
Keywords
Atrioventricular block, Fibrinolysis, Percutaneous coronary intervention, Rural health, Shock cardiogenic, ST elevation myocardial infarction