Coronary Artery Disease - STEMI Case #3 - Question #2 Answer

He is treated with fibrinolytic therapy, and his ST segment elevation improves on the ECG. He remains chest pain free, however has a change in his rhythm. The below ECG is obtained:


What is the appropriate treatment?

A. No treatment is necessary

B. Lidocaine infusion

C. Amiodarone infusion

D. Bretylium infusion


The ECG shows ventricular bigeminy, which is simply frequently premature ventricular contractions occurring every other beat. This is a benign rhythm, and no therapy is required. The CAST trial demonstrated increased mortality using encainide, flecainide and moricizine to suppress PVCs after an acute coronary syndrome. Similarly, the prophylactic administration of lidocaine to suppress PVCs or prevent ventricular tachycardia or vetnricular fibrillation is not recommended after STEMI.