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Dopamine Fails in Total AV Block Case

A 60-year-old male patient presented with chest pain and was found to have an inferior STEMI, RV infarction, and third-degree heart block. Dopamine was administered to stabilize the heart rate but failed to increase it above 30 bpm over 36 hours. The patient was eventually transferred to another hospital with a heart rate of 35 bpm supported by a dopamine infusion. Total heart block carries a poor prognosis for recovery of the AV node function and is often caused by severe right coronary artery occlusion.

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63 views1 page

Dopamine Fails in Total AV Block Case

A 60-year-old male patient presented with chest pain and was found to have an inferior STEMI, RV infarction, and third-degree heart block. Dopamine was administered to stabilize the heart rate but failed to increase it above 30 bpm over 36 hours. The patient was eventually transferred to another hospital with a heart rate of 35 bpm supported by a dopamine infusion. Total heart block carries a poor prognosis for recovery of the AV node function and is often caused by severe right coronary artery occlusion.

Uploaded by

volcanflame
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

FAILURE TO STABILIZE HEART RATE USING MAXIMUM INFUSION DOSE OF

DOPAMINE IN UNSTABLE BRADYARRHYTHMIA CASE (TOTAL AV BLOCK


TYPE), PACEMAKER-DEPENDENT?

M. Rizky Felani1, M. Adhitya Nagara1, Revan Satrio1, Rangga Mandara1, Assilia Dharani1, Ferry Usnizar2
1
General Practitioner, Emergency Department of Hermina Hospital, Palembang
2
Internist-Cardiologist, Hermina Hospital, Palembang

INTRODUCTION ECG in Emergency Room

Total AV Block is a type of disrhythmia with the worst


prognosis toward permanent AV nodes’ function. Total
AV Block incidences is caused mostly by severe occlu-
sion in the RCA. Dopamine IV infusion is one of the
drugs of choice to treat bradyarrhythmia.

ECG in Intensive Care Unit

CASE DESCRIPTION
A 60-year-old male patient was admitted to the ER
with chief complaint of burning sensation in epigas-
trium starting ± 26 hours before. BP was 90/60
mmHg with HR at 30 bpm, ECG showed Inferopos-
terior STEMI + RV Infarction + Total AV block
with Junctional Escape Rhythm (Intranodal
DISCUSSION
Block). Br adyar r ythmia and ACS algor ithm were Total AV Block is a type of disrhythmia with the

performed simultaneously with the administration of worst prognosis toward permanent AV nodes’ func-

SA 0.5 mg IV, aspilet 320 mg, CPG 300 mg, panto- tion. Total AV Block incidences is caused mostly by

prazole 20 mg IV, oxygen with nasal cannula 5 l/m, severe occlusion in the RCA. Dopamine IV infusion is

lovenox 30 mg IV, 250 cc RL loading, and the prep- one of the drugs of choice to treat bradyarrhythmia.

aration for ICU transfer (A-type hospitals’ ICCU are


full). SA administration didn’t give any results to-
ward HR, therefore titrated dopamine infusion was
administered. 36 hours later, patient was finally be
CONCLUSION
able to be referred to A-type hospital. Prior to refer- Total AV Block is a type of disrhythmia with the

ral, HR was still 35 bpm, BP 95/70 mmHg, with do- worst prognosis toward permanent AV nodes’ func-
tion. Total AV Block incidences is caused mostly by
pamine infusion (20 mcg/kg/min), lovenox 60 mg
severe occlusion in the RCA. Dopamine IV infusion is
SC (every 12 hours), and fluid therapy.
one of the drugs of choice to treat bradyarrhythmia.

REFERENCES :
1. American Heart Association (AHA). 2016. Provider Manual : Advanced Cardiovascular Life Support (ACLS). USA.
2. European Society of Cardiology (ESC). 2017. ([Link]
3. Lilly, LS. 2016. Pathophysiology of Heart Disease (6th Edition). Libr ar y of Congress Cataloging-in-Publication Data. USA.
4. Chan TC, et al. 2005. ECG in Emergency Medicine and Acute Care. Elsevier Mosby. Philadelpia, USA.

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