New insights into the management of rhythm and conduction disorders after acute myocardial infarction

PATIENT Male, 53 FINAL DIAGNOSIS: Myocardial infarction Symptoms: Chest pain • tachycardia MEDICATION - Clinical Procedure: - Specialty: Cardiology. OBJECTIVE Challenging differential diagnosis. BACKGROUND Comorbidities, including obesity and sleep-breathing disorders, can adversely influence outcomes in acute myocardial infarction (AMI), and should be considered in diagnosis and treatment administration. CASE REPORT The case demonstrates the difficulties of treating a middle-aged Caucasian patient with multiple comorbidities that could be overcome by a personalized approach and evaluation of concomitant sleep-breathing disorders (by polysomnography study). Diagnosis and treatment of sleep apnea by positive airway pressure (PAP therapy) played a pivotal role in heart rate and rhythm control. CONCLUSIONS In this case, effective PAP therapy enabled titration of antiarrhythmic drugs (to maximal doses) to achieve heart rate control and to eliminate severe ventricular tachyarrhythmias and contributed to the better recovery in a post-AMI patient with left ventricular systolic dysfunction.