Department of Internal Medicine, Staten Island University Hospital- Northwell Health, 475 Seaview Avenue, Staten Island, NY, USA.
Department of Internal Medicine, Staten Island University Hospital- Northwell Health, 475 Seaview Avenue, Staten Island, NY, USA.
Heart Lung. 2020 Mar-Apr;49(2):198-201. doi: 10.1016/j.hrtlng.2019.06.002. Epub 2019 Jun 24.
Acute electrocardiogram abnormalities are common in patients afflicted with pulmonary embolism (PE). Rarely, a patient with acute pulmonary embolism and electrocardiogram changes may have an underlying conduction abnormality that complicates their course.
We describe a patient with known history of left bundle branch block who presented with acute PE and developed a right bundle branch block, which devolved into complete third degree heart block without ventricular escape rhythm and led to concomitant hemodynamic compromise.
Given the rarity of this clinical scenario, we call for clinicians to be aware of PE-associated conduction pathology as well as the possibility that malignant cardiac conduction blocks may occur in the setting of PE particularly if the patient is known to have underlying conduction system disease. We emphasize the importance of continuous telemetry monitoring in patients presenting with PE as these types of arrhythmic complications and hemodynamic decompensation has been observed.
患有肺栓塞 (PE) 的患者常出现急性心电图异常。极少数情况下，急性肺栓塞和心电图改变的患者可能存在潜在的传导异常，使病情复杂化。
我们描述了一位已知左束支传导阻滞病史的患者，其出现急性 PE 并发展为右束支传导阻滞，继而演变为无室性逸搏的完全三度心脏阻滞，并伴有伴随的血流动力学障碍。
鉴于这种临床情况较为罕见，我们呼吁临床医生注意 PE 相关的传导病变，以及恶性心脏传导阻滞可能发生在 PE 患者中的可能性，特别是如果患者已知存在潜在的传导系统疾病。我们强调在出现 PE 的患者中进行连续遥测监测的重要性，因为已经观察到这些类型的心律失常并发症和血流动力学失代偿。
