# Acute Chest Pain and ST-Segment Changes in a Patient After Permanent His-Bundle Pacing Pacemaker Implantation

## TL;DR

A patient with a His-bundle pacemaker experienced chest pain and ST-segment changes, leading to a quick diagnosis of heart attack and successful treatment.

## Contribution

Highlights the importance of ECG in diagnosing heart attacks in patients with physiological pacing.

## Key findings

- ST-segment changes were correctly diagnosed as acute myocardial infarction.
- Prompt treatment led to a short door-to-balloon time and good recovery.
- Physiological pacing allows reliable ECG interpretation for heart attack diagnosis.

## Abstract

Diagnosis of ST-segment changes is challenging in patients with right ventricular pacing rhythm. Herein, we present a patient with a history of permanent His-bundle pacemaker implantation who developed chest pain and ST-segment changes on electrocardiography. An immediate diagnosis of acute myocardial infarction on the basis of the electrocardiographic abnormality and prompt management of coronary intervention resulted in a short door-to-balloon time of 80 minutes, even on a holiday morning, and a stable clinical course thereafter. This scenario underscores the potential benefit of electrocardiographic diagnosis in physiological pacing using a native conduction system, associating prompt treatment with a favorable prognosis.