Invasive Strategy of STEMI in Patients with TAVB, RBBB, and Dual High-Risk Profiles: Navigating the Challenges of Antithrombotic Therapy – A Case Report

Highlights:

1. The complexity of managing high-risk STEMI patients with significant conduction abnormalities and bleeding risk.

2. Right bundle branch block (RBBB) and total AV block complicate an uncommon, high-risk STEMI case.

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Background: It is imperative to diagnose and treat acute coronary occlusion as soon as possible, especially in patients with complicated conduction anomalies. Although electrocardiography (ECG) is still the gold standard for diagnosis, it has drawbacks, particularly when conduction abnormalities such as bundle branch block are present.

Case Summary: In this case study, a 60-year-old woman with cardiovascular risk factors and type 2 diabetes had an anteroseptal STEMI that was worsened by RBBB and total AV block. The patient's recovery was complicated by extensive gastrointestinal bleeding after a successful percutaneous coronary intervention (PCI) and the implantation of a stent in the left anterior descending artery.

Conclusion: In addition to highlighting the difficulties of striking a balance between dual antiplatelet therapy (DAPT) and reperfusion strategies in a high bleeding risk setting, this also highlights the management of a high-risk STEMI patient with total atrioventricular (AV) block, right bundle branch block (RBBB), and severe gastrointestinal complications.

Keywords: Bleeding risk; RBBB; STEMI; Total AV Block