eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2016-05-03 4 4 148 149 10.12691/ajmcr-4-4-10 AJMCR20164410 article Moustafa Elsheshtawy melsheshtawymd@gmail.com; moustafa.elsheshtawy@nychhc.org 1 Vasudev Virparia 1 Falgun Patel 1 Ashok Khanna 1 Division of Cardiology, Department of Medicine, Coney Island Hospital, Brooklyn, NY 11235, U.S.A. The material has not been previously published elsewhere and is being considered solely by the American Journal of Medical Case Reports. This case report determined to be 'A Healthcare Operations Activity and does not include Human Research - Institutional Review Board approval is not required' by Maimonides Institutional Review Board, an institutional ethics committee. http://pubs.sciepub.com/ajmcr/4/4/10/ajmcr-4-4-10.pdf Epidural infusion Local anesthetic Ropivacaine sinus arrhythmia