First degree AV block associated with acute anterior wall myocardial infarction

A 48 years old male comes to JIPMER hospital, Pondicherry with chief complaints of acute onset retrosternal chest pain of three hours duration along with breathlessness. There was no history of nausea, vomiting, giddiness. Patient was a known case of chronic smoker since last 40 years and used to smoke 10 cigarettes daily. There was no history of diabetes mellitus, hypertension, past history of coronary artery disease, or family history, or dyslipidemia. During evaluation in the emergency department patient pulse was 50 beats per minute, cardiovascular system was normal, Respiratory system was normal and there were no crepitation or rhonchi. ECG of the patient done in the emergency is shown below.

ECG 1 (Click on the image to enlarge it)

 Description of the ECG-Normal sinus rhythm at 54 beats per minute, normal axis, PR interval was significantly prolonged with PR interval being 280 msec, narrow QRS with ST segment elevation in lead V2-V5, I, avL, with ST segment depression in lead III,avF so the ecg was suggestsive of acute anterior wall myocardial infarction with first degree AV block.

Patient was immediately thrombolysed with streptokinase, post thrombolysis ecg at 90 minute  is shown below.

                                                           ECG 2(Kindly compare this ecg with ECG 1)

Description of the ECG-Normal sinus rhythm with rate 75 beats per minute, PR interval now 200 msec, there is resolution of ST segement elevation by more than 50% in all the lead (V2-V5, I,avL), although resolution of ST segment in lead V4 is less as compared to other lead. QS complex were present in lead V1-V3, few Ventricular premature complexes are also present. So patient underwent successful thrombolysis.