Download Stroke Event in Complete Heart Block and Sinus Node Dysfunction

Stroke Event in Complete Heart Block and Sinus Node Dysfunction : A Rare and
Unusual Case Report
Arrhythmia is the term used for an irregularity or rapidity of the heart beat or an
abnormal heart rhythm. There are two types of common arrhythmia, bradyarrhythmia
and tachyarrhythmia. Based on the location, bradyarrhythmia divide to 3 types : sinus
bradycardia and sick sinus syndrome (SA node), conduction blocks and junctional
escape rhythm (AV node), and ventricular escape rhythm (ventricles).
Sinus node dysfunction (SND) refers to abnormalities in sinus node impulse formation
and propagation. Dysfunction of the sinus node or failure to conduct electrical impulses
through the AV node and conducting bundles may cause marked slowing of the
heartbeat, a bradycardia of 32 - 40 beat per minute. Sinus node dysfunction is referred
to as sick sinus syndrome when it is accompanied by symptoms such as dizziness or
syncope.
Complete heart block is complete failure of conduction between the atria and ventricles.
In adults, the most common causes are acute myocardial infarction and chronic
degeneration of the conduction pathways with advanced age. As a result of the slow rate,
patients frequently experience light-headedness or syncope.
Arrhythmia may increase the risk of conditions such as stroke and heart failure. And
stroke due to arrhythmia ist most often caused by atrial fibrillation.
In this case, the patient had a stroke clinically without atrial fibrillation. He had complete
heart block and sinus node dysfunction.
Keywords : Stroke, Complete Heart Block, Sinus Node Dysfunction
Case History :
A-44 years old Male carried by his family to Emergency Room with unconsciousness
suddenly after dinner. He had vomitting while on the trip to the hospital. There were no
diabetes mellitus type II, hypertension, and heart disease before. He was only a smoker.
On physical examination, a low heart rate 38 beat per minute and hemiplegi on his left
extremity were found.
The laboratorium examination showed there was only increasing of CKMB 54 but
normal value of serial troponin I 0,00.
From the electrocardiogram, a complete heart block with there was only three of P
wave at 6 seconds record and left bundle branch block.
There was no abnormality in head CT Scan.
Patient decided to implant of temporary pacemaker (TPM), which was set on heart rate
80, treshold 0.5 mA, and output 1mA.
After that, echocardiogram was performed and showed dilatation of left ventrikel with
ejection fraction 48%, and hypokinetic of partial inferior wall.
Patient decided to angiography coronary and his result was normal.
3 Days after implant of TPM, there was no progression of his heart rate and decided to
implant of permanent pacemaker (PPM).
9 Days after implant of PPM, patient can be outpatient without complaint and his left
superior extremity can be lifted by himself but his inferior extremity can not be moved.
Now his mobility with a stick and he still continue control for his PPM. When reprogram
of his PPM performed, there were still sinus node dysfunction and AV node dysfunction.
Discussion