Best Cases: Ischemic Heart Disease-Advanced Heart Block secondary to Delayed Myocardial Edema: Cardiac MRI and Histological Tissue Characterization

Advanced Heart Block secondary to Delayed Myocardial Edema: Cardiac MRI and Histological Tissue Characterization

Video Transcription

Video Summary

A 32-year-old smoker presented with an inferior STEMI from a thrombotic left circumflex occlusion and underwent PCI. One week later, he returned with bradycardia and progressing AV block to complete heart block. Serial biomarkers excluded reinfarction, and cardiac MRI showed inferior wall scar plus significant myocardial edema, suggesting delayed conduction disease from post-infarct inflammation rather than ischemia. His rhythm improved spontaneously to first-degree AV block, so pacemaker implantation was deferred. Follow-up MRI showed resolving edema. The case highlights a bimodal pattern of post-MI edema and the value of cardiac MRI in explaining delayed AV block and avoiding unnecessary procedures.

Keywords

inferior STEMI

complete heart block

cardiac MRI

myocardial edema

post-infarct inflammation