Inferior STEMI and High-Grade AV Block As The Leading Causes of Head Injury: How to Manage Them?

First Author pada Abstrak “Inferior STEMI and High-Grade AV Block As The Leading Causes of Head Injury : How to Manage Them?”

 

Ditampilkan sebagai 10 Terbaik Poster Case Report pada The 18^th Annual Progress In Cardiovascular Disease (APICD) 2019

Inferior STEMI and High-Grade AV Block As The Leading Causes of Head Injury: How to Manage Them?

Akhmad I. Nurudinulloh^1,2, Putri R. Indrisia², Cut A. Rahmi³, P. Rahasto⁴

¹General Practitioner, Sari Asih Sangiang Hospital

²General Practitioner, Tangerang General Hospital

³Cardiologist, Sari Asih Sangiang Hospital

⁴Department of Cardiology and Vascular Medicine, Tangerang General Hospital

Background

Concomitant head injury and acute myocardial infarction is uncommon medical emergency condition that is found at Emergency Department (ED). The challenge for physicians regarding the diagnosis and management of this situation is needed to reduce morbidity and mortality.

Objective

To present a case of Inferior STEMI with high-grade AV Block complicated with head injury and choice of reperfusion treatment.

Case Illustration

A 50 years old male came to ED with mild head injury (GCS score 15) after falling down and experiencing syncope episode for about 20 minutes. There were an open wound on his head, headache, epigasric pain, and no chest pain. The patient had a history of DM type 2. Upon examination, patient’s hemodynamic was stable with normal blood pressure, no signs of hypoperfusion, and no neurological deficits. The patient was initially suspected of having a lucid interval of intracranial hemorrhage with another differential diagnosis of cardiac emergence. The electrocardiogram (ECG) showed acute inferior STEMI with high-grade AV Block, blood glucose was 587 mg/dL, then the Head CT Scan showed no abnormalities. Patient was given treatment for open wound bleeding, controlled pain with morphine, controlled blood glucose levels, and was given Dual Antiplatelet Therapy (DAPT) after CT scan had finished. Patient was referred to another hospital to get an early invasive strategy. Primary PCI found CAD 3 VD and revascularized at RCA. On Day 4 patient showed improvement and ECG showed beat of Sinus Rhythm.

Conclusion

The electrocardiogram is an important modality in all patients with syncope, even though patients are in the category of physical trauma patients. There is a presently no consensus guideline for management of STEMI concomitant with head injury. The patient’s management is based on elimination of the possibility of intracranial bleeding, and rescuing the heart early.

Keywords: STEMI, head Injury, syncope, electrocardiogram

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