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A Benign Case of Supraventricular Extra Systole in Acute Coronary Syndrome: Is It Harmful?

Author : R. Pranata, W.Wiharja, V. A. Damay
Upload Date : 19-04-2018

Introduction: In acute coronary syndrome (ACS) there are several ECG changes such as ST segment change, but other ECG changes can also occur such as Supraventricular Extra Systole (SVES) that presents in this case. SVES can be treated with antiarrhythmic agents such as lidocaine depends on the patient’s condition.

Case Report: A 66-year old woman came to the hospital with chief complaint of chest pain since 5 hours before admission. The pain worsened with activity and the symptom was accompanied with profuse sweating. No radiation of pain was reported. No shortness of breathing was reported. The patient has a long-standing uncontrolled hypertension and diabetes mellitus. On admission, the patient blood pressure was 160/90 mmHg, HR 88 bpm, RR 18x/min, temperature 36,7ºC, Her physical examination showed nothing remarkable. Her ECG showed an irregular rhythm, HR 84 bpm, normoaxis, and showed SVES. Her blood study of CK-MB showed no elevation. The patient was diagnosed with unstable angina pectoris. The patient was treated initially with O2, ISDN, Trombo aspilet, clopidogrel, and lovenox. The patient then admitted to ICCU for further observation. Day 6 post admission the patient’s symptoms are reduced and the patient was discharged.

Discussion: SVES might be a benign and malignant condition. Malignant SVES can be characterized with hemodynamic instability, R on T phenomenon changes in ECG (three or more in a row), and multiform PVC. In this patient, these condition were not found, so the patient had a benign SVES. Therefore antiarrhythmic medications weren’t necessary to treat the patient. Then we prefer to treat the ischemic symptoms that occurred in the patient.

Conclusion: Even though in the condition was a benign SVES, we suggest hemodynamics and ECG monitoring in this patient because malignant SVES could occur sporadically.

KEYWORDS : arrhythmia, ischemia, treatment.

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