Post myocardial infarction left bundle branch block disappearing with levosimendan

A 51 year old man presented with a Killip III acute anterior myocardial infarction due to a very late thrombosis of a stent in the proximal left anterior descending artery. the eKg after being admitted to the coronary care unit following primary pCI showed a new onset left bundle branch block (lBBB) (Figure 1: A). In spite of the initial favorable evolution throughout the first two days under treatment with diuretics and ACe inhibitors, the lBBB persisted. during the third day congestive signs worsened, together with a reduction in diuresis and worsening of the renal function. At that point, treatment with 0.1 mcg/kg/ min levosimendan perfusion was administered for 24 hours. During the first hours of perfusion the LBBB disappeared in the monitor and the eKg at the end of the perfusion showed narrow Qrs with persistent st elevation (Figure 1: B).