Acute Anterior ST-Elevation Myocardial Infarction With Right Bundle Branch Block Complicated by Complete Atrioventricular Block and Cardiogenic Shock in a 21-Year-Old Man: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute anterior ST-elevation myocardial infarction (STEMI) complicated by complete atrioventricular block, right bundle branch block, and cardiogenic shock (n=1). Intervention: Primary percutaneous coronary intervention (GuReater CoCr Sirolimus-eluting Coronary Stent System) and temporary transvenous pacing (PACE 101 H). Primary outcome: Restoration of coronary blood flow (TIMI flow grade) and recovery of atrioventricular conduction and hemodynamic status.

Q: What does this research mean for the field?

Timely primary percutaneous coronary intervention can reverse cardiogenic shock and complete atrioventricular block without the need for permanent pacing in young adults presenting with severe acute anterior STEMI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Nicholas Wijaya; Hanif Ardiansyah Sulistya; Yusuf Arifin; Arief B Santosa; Fazel N Lucius

doi:10.7759/cureus.117374

October 2, 2026CureusOpen Access

Acute Anterior ST-Elevation Myocardial Infarction With Right Bundle Branch Block Complicated by Complete Atrioventricular Block and Cardiogenic Shock in a 21-Year-Old Man: A Case Report

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Key result

Primary PCI with temporary pacing resolves complete heart block and shock in young anterior STEMI.

n=1

Why the study?

Acute STEMI is uncommon in very young adults and may present with atypical symptoms leading to delayed recognition and severe complications despite limited cardiovascular risk factors.

Does timely primary percutaneous coronary intervention and temporary transvenous pacing restore hemodynamic stability and atrioventricular conduction in a 21-year-old man with acute anterior STEMI complicated by cardiogenic shock, complete atrioventricular block, and right bundle branch block?

Key Points

To describe the clinical presentation, emergency management, and recovery of a 21-year-old man presenting with acute anterior STEMI complicated by right bundle branch block, complete atrioventricular block, and cardiogenic shock.
Clinical case evaluation of a 21-year-old male who initially presented with epigastric pain treated for presumed gastrointestinal disease before electrocardiography identified acute anterior STEMI.
Emergency interventions included temporary transvenous pacemaker insertion to manage complete atrioventricular block followed by primary percutaneous coronary intervention with a sirolimus-eluting coronary stent.
Coronary angiography showed total occlusion of the left anterior descending artery, and stenting successfully restored TIMI grade 3 flow.
Reperfusion led to rapid hemodynamic stabilization and resolution of atrioventricular conduction disturbances, allowing temporary pacemaker removal without requiring permanent pacemaker implantation before discharge on day 4.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does timely primary percutaneous coronary intervention and temporary transvenous pacing restore hemodynamic stability and atrioventricular conduction in a 21-year-old man with acute anterior STEMI complicated by cardiogenic shock, complete atrioventricular block, and right bundle branch block?

P

Population

1 young adult man (aged 21 years) with acute anterior STEMI complicated by Killip class IV cardiogenic shock, complete atrioventricular block, and right bundle branch block, followed for 4 days until hospital discharge.

I

Intervention

Temporary transvenous pacing (PACE 101 H set at 70 beats/minute) followed by primary percutaneous coronary intervention (PCI) with balloon pre-dilatation (2.0 x 15 mm) and deployment of a 3.0 x 36 mm sirolimus-eluting coronary stent (GuReater CoCr) from the ostial to mid-LAD at 15 atm, alongside vasopressor/inotropic support (IV dopamine 5-20 mcg/kg/min, IV norepinephrine 0.05 mcg/kg/min) and pharmacotherapy (aspirin 320 mg loading then 80 mg maintenance, clopidogrel 300 mg loading then 75 mg maintenance, atorvastatin 80 mg then 40 mg maintenance, subcutaneous enoxaparin 60 mg twice daily, IV omeprazole 40 mg twice daily, and IV ceftriaxone 1000 mg three times daily).

O

Outcome

Restoration of coronary flow (TIMI grade 3 flow), hemodynamic stabilization, and recovery of atrioventricular conduction without permanent pacemaker implantation by hospital discharge on day 4.hard clinical

This case report demonstrates that extensive anterior STEMI complicated by cardiogenic shock and complete atrioventricular block can occur in very young adults with atypical epigastric symptoms, and prompt primary PCI can rapidly reverse ischemia-induced infranodal conduction block without requiring a permanent pacemaker.

Limitations

Single-patient case report design
Baseline and post-revascularization transthoracic echocardiograms were not performed due to hyperacute presentation and insurance limitations
Comprehensive lipid profile evaluations were not performed due to strict insurance limitations and early discharge
Comprehensive etiological screenings for premature coronary thrombosis (inherited thrombophilia, lipoprotein(a), autoimmune panels, or advanced vascular imaging) were not performed
Patient declined further outpatient investigations after discharge on hospital day 4
Baseline transthoracic echocardiogram was not performed due to hyperacute presentation with profound hemodynamic instability prioritizing immediate primary PCI.
Post-revascularization echocardiogram and comprehensive lipid profile evaluations were not performed due to strict insurance limitations and early discharge.
Comprehensive etiological screenings for premature coronary thrombosis (inherited thrombophilia, lipoprotein(a), autoimmune panels) or advanced vascular imaging were not performed due to resource limitations and hyperacute presentation.
The patient declined further outpatient investigations.

Implication

May support prompt primary PCI plus temporary pacing to avoid permanent pacemaker in young anterior STEMI; hypothesis-generating, needs prospective validation.

Abstract

Acute ST-elevation myocardial infarction (STEMI) is uncommon in very young adults and may initially present with atypical symptoms, resulting in delayed recognition.Severe complications, such as cardiogenic shock and advanced conduction disturbances, can still occur despite limited conventional cardiovascular risk factors.A 21-year-old man initially presented with epigastric pain and was treated for a presumed gastrointestinal disorder.Further evaluation with electrocardiography later revealed acute anterior STEMI.On admission, he was hypotensive and bradycardic, with cardiogenic shock, complete atrioventricular block (CAVB), and right bundle branch block (RBBB).Coronary angiography demonstrated total occlusion of the left anterior descending artery.A PACE 101 H temporary transvenous pacemaker (Osypka Medical, Berlin, Germany) was inserted before primary percutaneous coronary intervention.Revascularisation using a GuReater CoCr Sirolimus-eluting Coronary Stent System (Lepu Medical Technology (Beijing) Co., Ltd., Beijing, China) successfully restored TIMI grade 3 flow.Following reperfusion, hemodynamic status and atrioventricular conduction improved rapidly, allowing pacemaker removal without permanent pacing.This case shows that extensive anterior STEMI can still occur in very young adults despite limited conventional cardiovascular risk factors.Delayed diagnosis may lead to severe complications, including cardiogenic shock and CAVB.However, timely reperfusion may allow recovery of ischemia-related conduction disturbances without permanent pacemaker implantation.

Discussion

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Cite This Study

Wijaya et al. (2026) conducted a case report in Acute anterior ST-elevation myocardial infarction (STEMI) complicated by complete atrioventricular block, right bundle branch block, and cardiogenic shock (n=1). Primary percutaneous coronary intervention (GuReater CoCr Sirolimus-eluting Coronary Stent System) and temporary transvenous pacing (PACE 101 H) was evaluated on Restoration of coronary blood flow (TIMI flow grade) and recovery of atrioventricular conduction and hemodynamic status. Primary PCI with a sirolimus-eluting stent and temporary pacing restored TIMI 3 flow and resolved complete heart block and cardiogenic shock in a 21-year-old man with anterior STEMI.

synapsesocial.com/papers/6ac2ef2c70c065e257f28de8 https://doi.org/10.7759/cureus.117374

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Acute Anterior ST-Elevation Myocardial Infarction With Right Bundle Branch Block Complicated by Complete Atrioventricular Block and Cardiogenic Shock in a 21-Year-Old Man: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Acute Anterior ST-Elevation Myocardial Infarction With Right Bundle Branch Block Complicated by Complete Atrioventricular Block and Cardiogenic Shock in a 21-Year-Old Man: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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