Sick sinus syndrome, inferior myocardial infarct and stroke: a case report

ABSTRACT

This is a case report about a 35 years old male farmer, who presented to the neurology outpatient clinic, of a 510 bed teaching hospital in Sanaa - Republic of Yemen -On 19.12.1991, with right sided weakness, inability to speak [stroke]. He spent 6 days out before being admitted by a Neurologist into the general medical ward on 25.12.1991. After his reassessment and investigations, he was found to have a slow pulse 24/min. ECG No. 1 on 25.12.1991 revealed sick sinus syndrome, 1st degree AV block, and inferior infarct. Repeat ECG No. 2 on 30.12.1991 after Atropine injections did not show any improvement in the rate. His mild left ventricular failure responded to amiloride hydrochlorthiazide combination [Moduretic]. The right sided hemiparesis and aphasia improved over three weeks on piracetam [Nootropil], Aspirin and Dipyridamole [Persantin]. On 8.1.1992 he was transferred to the intensive care unit for Halter's monitoring to watch any brady-tachyarrhythmia syndrome and re-evaluate atropine responses ECG No. 3 showed sinus arrest typical of sick sinus syndrome without response to atropine 0.5 mg Q.D.S. No bradytachycardia syndrome was recorded over one week on monitor. Salbutamol 2 mg Q.D.S. was started after stopping atropine orally which increased the heart rate by 25-50 percent i.e. the pulse 24 beat/min. became 30-36 beats/min ECG No 4. Many biochemical, blood tests were normal, chest P.A. film showed borderline cardiomegaly with mild pulmonary conjestion, ECHO did not show any valvular lesion. CAT scan was out of order, No pace maker. Patient was discharged to go abroad for more investigations and Pace-marker