KUMJ | VOL. 23 | NO. 3 | ISSUE 91 | JULY-SEPTEMBER, 2025

Reversing AV Block and Cardiogenic Shock in STEMI Care: A Case Report on Use of Fibrinolysis and Inotrope without PCI in Rural Nepal
Pradhan A, Tamrakar P, Bhandari J, Mahat P

Abstract:
Atrioventricular block and cardiogenic shock are critical complications of inferior wall myocardial infarction with high mortality, especially in resource-limited settings lacking percutaneous coronary intervention. We report a 53-year-old male smoker presenting to a rural hospital with acute chest pain, dyspnea, and profound hemodynamic instability with electrocardiogram showing inferior wall ST-segment elevation myocardial infarction with Mobitz type I atrioventricular block. This case highlights reversal of atrioventricular block with return of hemodynamic stablility using Streptokinase and ionotropes in a rural setting. Therefore, timely fibrinolysis and inotropes in managing inferior wall myocardial infarction with atrioventricular block and cardiogenic shock in percutaneous coronary intervention -inaccessible regions and strengthening rural ST segment elevation myocardial infarction care networks is crucial.
Keyword : Atrioventricular block, Fibrinolysis, Percutaneous coronary intervention, Rural health, Shock cardiogenic, ST elevation myocardial infarction