A 68 years old gentleman was admitted to the primary care hospital with Anterior Wall Myocardial Infarction of 12 hrs duration. He was not thrombolyzed. Subsequently patient developed CHB and Hypotension and hence referred at Nagpur next day.

On admission, he had Anterior Myocardial Infarction with Complete Heart Block. BP was 80/60 mmHg. He had oliguria. His Sr. Creatinine was 4.0mg%. He was diagnosed as a case of AWMI with Cardiogenic Shock with complete Heart Block. Subsequently patient was put on Intra Aortic Balloon support.

Patient was subjected to immediate Coronary Angiography with an intention to perform Coronary Angioplasty to LAD. His Coronary Angiography revealed Single Vessel Disease with total obstruction of Mid LAD. Inj. Integrillin IV Double Bolus was given and infusion was continued for 24 hrs. The stenosis was crossed by ACS All Star Guide Wire. The balloon dilatation was performed with Euca 2.5x20mm balloon. Further elective stenting was done with 2.5x33 mm Pronova Sirolimus Eluting Stent. The procedure was successful with no residual stenosis with TIMI 3 flow.

The IABP was removed after 48 hrs and HP was 100/80mmHg without any ionotropic support. Permanent Pacemaker Implantation (VVI Shree Pacetronix Pacemaker) was done successfully after 3 days. The patient was discharged from the hospital on the 101h day of his admission. On discharge, his Sr. Creatinine was 1.8mg%.

The patient was reviewed after 3 months. He had no exertional angina. Sr. Creatinine was 1.2mg%. His 2D Echo revealed Apical Dyskinesia, Hypokinesia of Anterolateral wall and LVEF was 30%.


Coronary angiography at the time of anterior myocardial infarction (left panel) and a 24 months follow?up (right panel). The left coronary artery is shown in the upper part of both panels whereas the right coronary artery in shown in the lower part. In the 2005 coronary angiography a thrombotic occlusion of the left anterior descending artery is marked by the white arrow (in the frame the angiographic result after 2 drug?eluting?stents [DES] implantations). In the 2007 coronary angiography a wide stent patency is shown, whereas a critical stenosis on the middle right coronary artery is marked by the black arrow.