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
- 1Emergency Department, Dr. Soepraoen Army Hospital, Malang, IDN
- 2Cardiology and Vascular Medicine Department, Dr. Soepraoen Army Hospital, Malang, IDN
- 3Medical School, Universitas Sumatera Utara, Medan, IDN
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.
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BibTeX
@article{wijaya2026acute,
title = {{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}},
author = {Nicholas Wijaya and Hanif A Sulistya and Yusuf Arifin and Arief B Santosa and Fazel N Lucius},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117374},
url = {https://europepmc.org/article/PMC/PMC13725116},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Nicholas Wijaya
AU - Hanif A Sulistya
AU - Yusuf Arifin
AU - Arief B Santosa
AU - Fazel N Lucius
PY - 2026
DA - 2026/10/02
JO - Cureus
DO - 10.7759/cureus.117374
UR - https://europepmc.org/article/PMC/PMC13725116
AB - 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.
SN - 2168-8184
ER -