PMC3700499_01
The 12-lead electrocardiogram and left ventriculogram obtained on admission during hemodynamic collapse. (A) The 12-lead electrocardiogram; arrow indicates the spike in ventricular pace. (B) The left ventriculogram viewed from the right, anterior, oblique perspective.
amjcaserep-14-116-g001.jpg
PMC3700499_01_amjcaserep-14-116-g001.jpg
f1-amjcaserep-14-116
The electrocardiogram obtained in the CICU revealed an accelerated idioventricular rhythm with ST-segment elevation in II, III, and aVF leads and more prominent in V2-V6 leads (Figure 1A). The left ventriculogram pictured in Figure 1B displays global systolic dysfunction with an EF of 22%.
Serial changes in heart rhythm, QRS morphology, and QRS width.
amjcaserep-14-116-g002.jpg
PMC3700499_01_amjcaserep-14-116-g002.jpg
f2-amjcaserep-14-116
Between days 1 and 3 of treatment, the QRS width progressively increased from 0.18 s to 0.44 s (Figure 2). On day 4, the ventricular pacing rhythm was restored and the QRS width was decreased to 0.14 s, consistent with pre-admission QRS width until day 11 (Figure 2).
Time courses of CK, CRP, and LVEF. CK - creatinine kinase; CRP - C-reactive protein; LVEF - left ventricular ejection fraction; MP - methylprednisolone.
amjcaserep-14-116-g003.jpg
PMC3700499_01_amjcaserep-14-116-g003.jpg
f3-amjcaserep-14-116
By day 3, CRP levels reached 36.6 mg/dL and CK levels were 8,078 IU/L (Figure 3). As shown in Figure 3, the CK levels declined sharply and returned to its normal limit until day 12.