Case 2:

63-year old woman presented with central chest pain of two hours duration. On examination her blood pressure was 90/60 mm Hg, she had a weak pulse, distended neck veins with elevated jugular venous pressure, normal first and second heart sounds and lung fields were clear on auscultation.

Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

 

Main Index

Table Of Contents

Question 11 of 17:

Atrio-ventricular sequential pacing often improves hypotension when RV infarct is accompanied by a high-degree atrioventricular block.

You clicked 'True'

Correct!

One of the important factors for sustaining adequate right ventricular preload is maintenance of atrio-ventricular synchrony. High-degree heart block is common in right ventricular infarction, occurring in as high as 50% of these patients (1). Atrio-ventricular sequential pacing leads to a significant increase in cardiac output and reversal of shock, even when ventricular pacing alone has not been of benefit (2).

Reference:

1. Braat SH, De Zwaan C, Bruguda P, Coenegracht JM, Wellens HJ. Right ventricular involvement of acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances. Am Heart J 1984;107:1183-1187.

2. Love JC, Haffajee CI, Gore JM, Alpert JS. Reversiblity of hypotension and shock by atrial or atrioventricular sequential pacing in patients with right ventricular infarction. Am Heart J 1984;108:5-13.

 
 
Produced by the Learning Resource Center Office of Medical Education University of Michigan Medical School
Copyright 2001 by the University of Michigan Board of Regents. All rights reserved.