case_images: PMC10599106_01
case_images: The ECG changes during admission. (a) The ECG showed ST-segment elevation in lead I, aVL on the admission day. (b) After 1 day, a new onset of complete right bundle branch block was revealed. (c) An abrupt high-degree atrioventricular block with a ratio of 2:1 was revealed on day 3 of admission.
case_images: 10.1177_2050313X231208513-fig1.jpg
case_images: PMC10599106_01_10.1177_2050313X231208513-fig1.jpg
case_images: fig1-2050313X231208513
case_images: An electrocardiogram (ECG) revealed ST-segment elevation in lead I, aVL (Figure 1(a)). Chest pain diminished, but an ECG revealed a new-onset complete right branch bundle block (Figure 1(b)). On the third day of admission, an ECG showed a high-grade atrioventricular block with a ratio of 2:1 (Figure 1(c)), which then changed into a total atrioventricular block.
case_images: (a) The decreased global longitudinal strain (GLS) value at the basal, middle, and apical segment of anterolateral wall (0%, 0%, -2%, respectively) on day 1 of admission. (b) The worsening GLS revealed at basal, middle, and apical segment of lateral, septal, and inferior wall on day 3 of admission. (c) Improvement of the left ventricle contractility measured by GLS. (d) Improved GLS evaluated in the outpatient ward.
case_images: 10.1177_2050313X231208513-fig2.jpg
case_images: PMC10599106_01_10.1177_2050313X231208513-fig2.jpg
case_images: fig2-2050313X231208513
case_images: A regional wall motion abnormality evaluation revealed a hypokinetic segment at the anterolateral with preserved left ventricle ejection fraction (LVEF 55%), confirmed by the depressed global longitudinal strain (GLS) parameters at the basal, middle, and apical segments of the anterolateral wall (0%, 0%, -2%, respectively) (Figure 2(a)). The hemodynamic parameters revealed a left ventricular outflow tract velocity time integral (LVOT VTI) of 10.5 cm, a cardiac index of 1.07 L/min/ml2, and a cardiac output of 2.02 L/min with mildly reduced EF (LVEF 37%) (Table 1), and depressed GLS was noted at the basal, middle, and apical region of lateral, anteroseptal, septal, and inferior walls (Figure 2(b)). The diagnosis was strengthened by improvement symptoms after 3 days of supportive treatment and anti-inflammatory colchicine, which converted into sinus rhythm, improved LVEF (44%), and improved wall contractility was confirmed by GLS (Figure 2(c)). The LV GLS was evaluated in the outpatient ward, it showed improvement at the basal, middle, and apical regions of the lateral, posterior, inferior, and septal walls (Figure 2(d)).