Abstract 13743: A Tale of Syncope, Prolonged QT and ICD

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isma N Javed ◽  
Nazir AHMAD ◽  
Deborah J Lockwood ◽  
Karen J J Beckman ◽  
Stavros Stavrakis
Keyword(s):  
Cardiac Arrest ◽  
Family History ◽  
Normal Sinus Rhythm ◽  
Beta Blockers ◽  
Strenuous Exercise ◽  
Caucasian Woman ◽  
Icd Implantation ◽  
Her Family ◽  
Normal Sinus ◽  
The 1960S

Introduction: Long QT syndrome (LQTS) was first described in the 1960s. It manifests clinically as syncope, cardiac arrest or sudden cardiac death. LQTS can be caused by 15 different genes. These mutations lead to action potential prolongation by causing impaired repolarizing currents. Case Discussion: A 29-year-old previously healthy Caucasian woman was admitted after recurrent episodes of syncope that happened within 1-month prior to the presentation. She was hemodynamically stable with normal vitals. Her ECG showed normal sinus rhythm with corrected QT (QTc) of 598ms. In the ED, she suffered an episode of sustained monomorphic ventricular tachycardia (VT) and underwent cardioversion. She was started on amiodarone infusion. Serial ECGs showed prolonged QTc. She had another episode of pulseless VT that terminated without defibrillation. She was transferred to our facility for further care. Her family history was significant for paternal aunt who had died unexpectedly at the age of 39. All her lab work including electrolytes, thyroid panel, cardiac enzymes, inflammatory markers and extended drug screen was unrevealing. Transthoracic echocardiogram showed normal biventricular size and function. Decision making: She was started on propranolol for possible LQTS. Cardiac MR did not show any evidence of structural abnormalities. Genetic panel was sent. Since myocarditis or familial LQTS could not be ruled out, we proceeded with implantable cardioverter defibrillator (ICD) implantation for secondary prevention. She was discharged home on nadolol. Conclusion: In the absence of genetic information, LQTS can be diagnosed in symptomatic patients with QTc >480msec on serial ECGs after excluding secondary causes. Schwartz score comprising of ECG findings, symptoms, clinical & family history is diagnostic when greater than 3.5. Beta-blockers are indicated in all patients with a clinical diagnosis. Patients must avoid any QT prolonging agents and strenuous exercise. An ICD is indicated in patients who suffered cardiac arrest. ICD may also be considered for primary prevention in high risk patients.

scholarly journals Initial Cardiac Rhythm Correlated to Emergency Department Survival

2009 ◽  
Vol 3 ◽  
pp. CMC.S695 ◽  
Author(s):  
Rade B. Vukmir
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Rhythm ◽  
Normal Sinus Rhythm ◽  
Cardiopulmonary Arrest ◽  
Pulseless Electrical Activity ◽  
Clinical Intervention ◽  
Normal Sinus ◽  
Service Environments ◽  
Double Blinded ◽  
Prehospital Cardiac Arrest

Background This study attempted to correlate the initial cardiac rhythm and survival from prehospital cardiac arrest, as a secondary end-point. Methods Prospective, randomized, double-blinded clinical intervention trial where bicarbonate was administered to 874 prehospital cardiopulmonary arrest patients in prehospital urban, suburban, and rural emergency medical service environments. Results This group's manifested an overall survival rate of 13.9% (110 of 793) of prehospital cardiac arrest patients. The most common presenting arrhythmia was ventricular fibrillation (VF) (45.0%), asystole (ASY) (34.4%), and pulseless electrical activity (PEA) (15.7%). Less commonly found were normal sinus rhythm (NSR) (1.8%), other (1.8%), ventricular tachycardia (VT) (0.6%), and atrioventricular block (AVB) (0.5%) as prearrest rhythms. The best survival was noted in those with a presenting rhythm of AVB (57.1%), VT (33.3%), VF (15.7%), NSR (14.3%), PEA (11.2%), and ASY (11.1%) (p = 0.02). However, there was no correlation between the final cardiac rhythm and outcome, other than an obvious end-of-life rhythm. Conclusion The most common presenting arrhythmia was VF (45%), while survival is greatest in those presenting with AVB (57.1%).

Case File: Cardiac amyloidosis using on routine hand-held ultrasound

POCUS Journal ◽  
2016 ◽  
Vol 1 (1) ◽  
pp. 3 ◽  
Author(s):  
Jeffrey Wilkinson, MD
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
General Hospital ◽  
Cardiac Amyloidosis ◽  
Normal Sinus Rhythm ◽  
Case File ◽  
Normal Sinus ◽  
Kingston General Hospital

A 64 year-old man presented to the Kingston General Hospital with cardiac arrest. At the time of EMS arrival, the ECG showed ventricular tachycardia. The patient was intubated and ventilated. Multiple defibrillations were required to convert the patient back to normal sinus rhythm.

scholarly journals A Case report of hemodynamic instability, cardiac arrest, and acute severe dyspnea subsequent to inhalation of crystal methamphetamine

2019 ◽  
Author(s):  
Farhad Gholami ◽  
Seyed Hamzeh Hosseini ◽  
Amirhossein Ahmadi ◽  
Maryam Nabati
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Normal Sinus Rhythm ◽  
Hemodynamic Instability ◽  
Acute Dyspnea ◽  
Crystal Methamphetamine ◽  
Electrical Shock ◽  
Mechanically Ventilated ◽  
Normal Sinus ◽  
History Of

Misuse of stimulants similar to amphetamine is a universal problem. These stimulants cause many complications in their abusers. However, myocardial infarction is rarely reported as a complication of amphetamine abuse. Herein, we report a man aged 42 years presented at the Emergency Department with the chief complaint of acute dyspnea following ice inhalation without history of dyspnea. Within the first hour and a half of admission, the patient was treated by nasal oxygen and bronchodilator aminophylline. However, he did not respond to the initial treatment and lost his consciousness; showed ventricular fibrillation, cardiac arrest, and hemodynamic instability. So, cardiopulmonary resuscitation was immediately initiated for him. The patient was intubated, mechanically ventilated. Also, the synchronized electrical shock was delivered 5 times (200-360 J) along with amiodarone (300 mg intravenously [IV] stat, then 1 mg/min IV infusion for 6 hours and next 0.5 mg/min for 18 hours) to treat the ventricular fibrillation. The arrhythmia was subsequently controlled, and his normal sinus rhythm was resumed. Two hours later, condition of the patient improved, and he was extubated. After two days, when the patient got stable, the echocardiography was performed, which was completely normal.

scholarly journals Metoclopramide-induced cardiac arrest

2011 ◽  
Vol 1 (4) ◽  
pp. 83 ◽  
Author(s):  
Martha M. Rumore ◽  
Spencer Evan Lee ◽  
Steven Wang ◽  
Brenna Farmer
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Injury ◽  
Normal Sinus Rhythm ◽  
Morbidly Obese ◽  
St Depression ◽  
Normal Sinus ◽  
Obese Female ◽  
Artery Disease ◽  
Electrocardiogram Ecg ◽  
Prescribing Information

The authors report a case of cardiac arrest in a patient receiving intravenous (IV) metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV) injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG) revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT) associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs) related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s) underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and reporting of bradydysrrhythmias and cardiac arrest in patients receiving metoclopramide.

Abstract 254: High Shock Efficacy and Algorithm Performance for a 150J Biphasic Waveform AED Used by Lay and BLS Responders During Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Stacy Gehman ◽  
Edward Kompare ◽  
Barbara Fink ◽  
Tim Johnson ◽  
Walter Hufford ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Normal Sinus Rhythm ◽  
Convenience Sample ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Normal Sinus ◽  
High Shock ◽  
Biphasic Waveform ◽  
Post Shock ◽  
Hospital Cardiac Arrest

Introduction: Effective AED defibrillation of out of hospital cardiac arrest (OHCA) depends on the safe and effective identification of shockable rhythms, and on delivery of effective defibrillation energy. This report summarizes rhythm detection performance and shock efficacy during OHCA uses of Philips HeartStart Home and OnSite AEDs using non-escalating 150 J therapy. Methods: A convenience sample of 185 OHCA AED patient uses were reviewed by clinical experts. All analysis periods that resulted in AED rhythm advisories (Shock Advised or No Shock Advised) were annotated. Shockable rhythm categories include VF and polymorphic VT/flutter. Non-Shockable rhythm categories include normal sinus rhythm, other rhythms (e.g., atrial fibrillation/flutter, bradycardia, SVT, idioventricular, bundle branch block), and asystole. Intermediate rhythms (benefits of defibrillation are limited or uncertain) were not included. Post-shock rhythm was categorized as shockable, non-shockable, or undeterminable (rhythms corrupted by CPR artifact or pads removal within 5-s of shock delivery). Shock success was defined as conversion to a non-shockable rhythm within 5-s post-shock. Results: A total of 487 analysis periods resulted in AED rhythm advisories, with 175 annotated as Shockable and 312 Non-shockable. Sensitivity and specificity (n/N, Exact 95% CI) were 97.7% (171/175, 94.3%, 99.4%) and 100% (312/312, 98.8%, 100.0%) respectively. A total of 165 shocks were delivered to 100 patients with 5 undeterminable post-shock rhythms. The remaining 160 shocks were delivered to 156 Shockable rhythm episodes. All shock efficacy was 96.9% (155/160, 92.9%, 99.0%): 150 episodes converted to non-shockable rhythms after one shock (96.2% (150/156, 91.8%, 98.6%)); 154 after two shocks (98.7% (154/156, 95.4%, 99.8%)); and 155 after three shocks, the first two of which were undeterminable (99.4% (155/156, 96.5%, 100.0%)). The remaining episode had a failed first shock, followed by an undeterminable second shock, which was the last shock of the use. Conclusion: For these 150J fixed-energy AEDs, OHCA defibrillation is safe (100% specificity), and effective (97.7% sensitivity; 96.2% single shock effectiveness; 98.7% after two shocks; 99.4% after three shocks).

P2280Incidence and predictors of alarms in patients with wearable cardioverter defibrillator (WCD) - results of the Austrian WCD Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Rohrer ◽  
M Manninger ◽  
T Odeneg ◽  
C Ebner ◽  
D Moertl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Option ◽  
Normal Sinus Rhythm ◽  
Effective Treatment Option ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
Normal Sinus ◽  
Appropriate Shocks

Abstract Background The wearable cardioverter-defibrillator (WCD) is a treatment option for patients at high risk for ventricular arrhythmia, either if the risk is potentially reversible or if an implantable cardioverter defibrillator (ICD) implantation is currently not possible. Methods We performed a retrospective analysis of all alarms in the cohort of the Austrian WCD registry between 2010 and 2018. Type of arrhythmias was assessed by independent review of two cardiologists. Results 25.540 automatically recorded ECGs in 605 patients (68%) were analyzed. 1125 ECGs showed sustained ventricular arrhythmias in 117 patients, 65 ECGs showed non sustained VTs. 24.415 ECGs in 488 patients showed inadequate alarms Reasons for inadequate alarms were artefacts (97%), pacemaker or t-wave oversensing (0,3%) and in 2,3% atrial fibrillation or SVTs. 5860 manually recorded ECGs in 608 patients (68%) were analyzed. 298 (5%) of these ECGs showed following arrhythmias: atrial fibrillation (34,7%), SVTs (28%), sinustachycardia (10,7%), non sustained VTs (12%) and sustained VTs or sustained slow VTs (6,7%), premature ventricular beats or bradycardia was identified in 8%. The remaining 5562 ECGs (95%) showed normal sinus rhythm. Of the 895 patients (60±14 years, 20% female), 34 (3,8%) received a total of 65 automatically triggered shocks (median 2; range 1–5). 31/895 (3.5%) patients received 57 appropriate shocks (median 1, range 1–5) for 49 arrhythmic events, whereas 7/895 (0.8%) patients received 8 inappropriate shocks (median 1, range 1–2). 44 events were successfully terminated with the first shock (85,7%) and 4 events were terminated with the second shock. In one patient, a shock treatment for VF was not successful. The time from event onset to shock was median 60 [40; 1187] sec. The median time from WCD prescription to a shock event was 8 days [1–151]. 23/ 34 patients (68%) received their first WCD shock within 30 days. Seven patients (0.8%) received a total of nine inappropriate shocks due to different reasons: artefacts (2 inappropriate shocks), non-shockable rhythms (asystole, weak action, 3 shocks) and atrial fibrillation with a bundle branch block in two cases. In one patient VF terminated spontaneously before the WCD treatment was delivered. Conclusion The WCD is an effective treatment option in patients with a high SCD risk but it also triggers a significant amount of alarms. Although many inadequate alarms occurred, adequate alarms led to arrhythmia detection such as in VT/VF events which were successfully terminated by the WCD in 3,4% of patients.

Abstract 16213: Short QT Syndrome Case Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lawrenshey Charles ◽  
Abdullah Al-Abcha ◽  
Tyler Kemnic ◽  
Zulfiqar Qutrio Baloch
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sudden Cardiac Death ◽  
Sinus Rhythm ◽  
Cardiac Death ◽  
Normal Sinus Rhythm ◽  
Short Qt Syndrome ◽  
Icd Implantation ◽  
Normal Sinus ◽  
Qt Syndrome

Introduction: Short QT syndrome (SQTS) is a very rare genetic disease of the electrical system of the heart which is associated with an increase risk of abnormal cardiac rhythms and sudden cardiac death. First described in 2000 with the first genetic mutation associated with SQTS described in 2004. We present a case of Short QT syndrome in a 53 year old male. Case: A 53 year old male with a PMH of HTN, alcohol abuse, and tobacco dependence presented to the ED with palpitations. Patient endorsed that he was in his usual state of health the day prior to arrival. He went to bed after drinking alcohol and woke up suddenly pale and diaphoretic with dyspnea and a persistent feeling of impending doom. On arrival to the ED, he was tachypneic (26 breaths/min) with a heart rate of 163 bpm and a blood pressure of 100/80 mmHg. EKG showed atrial fibrillation with RVR. The patient converted to normal sinus rhythm after one dose of IV Cardizem 10 mg was administered for rate control. The next day he had multiple episodes of Torsades de Pointe and monomorphic ventricular tachycardia treated with synchronized cardioversion, 2g of magnesium, IV amiodarone and lidocaine drip. He was transferred to the ICU for further evaluation and monitoring. Repeat EKG showed normal sinus rhythm at 75 bpm and short QT (QT= 328). TTE showed normal biventricular size and function (LVEF 60-65%) with no valvular abnormalities. Dual chamber Implantable Cardioverter Defibrillator (ICD) was placed and outpatient genetic testing was scheduled. Discussion: SQTS is very rare with roughly 70 cases identified worldwide since the condition was discovered in 2000. It is a congenital channelopathy related to potassium channels and represented by a normal heart rate with accelerated cardiac repolarization. Normal QT range is 350-440 msec while SQTS range is 210-340 msec. Mutations in the KCNH2, KCNJ2, or KCNQ1 genes lead to enhanced flow of potassium ions across the membrane of cardiac muscle cells. Patients can present at any age with palpitations, syncope, atrial fibrillation, and sudden cardiac death. The cornerstone to diagnosing SQTS is an electrocardiogram. Patients with SQTS can be managed with ICD implantation, quinidine (especially with KCNH2 mutation), and sotalol (with other mutations other than KCNH2).

scholarly journals Early lactate and glucose kinetics following return to spontaneous circulation after out-of-hospital cardiac arrest

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Pedro Freire Jorge ◽  
Rohan Boer ◽  
Rene A. Posma ◽  
Katharina C. Harms ◽  
Bart Hiemstra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Physiological Stress ◽  
Spontaneous Circulation ◽  
Strenuous Exercise ◽  
Rapid Rate ◽  
Glucose Kinetics ◽  
Initial Value ◽  
Extreme Stress ◽  
Arterial Ph ◽  
Hospital Cardiac Arrest

Abstract Objective Lactate has been shown to be preferentially metabolized in comparison to glucose after physiological stress, such as strenuous exercise. Derangements of lactate and glucose are common after out-of-hospital cardiac arrest (OHCA). Therefore, we hypothesized that lactate decreases faster than glucose after return-to-spontaneous-circulation (ROSC) after OHCA. Results We included 155 OHCA patients in our analysis. Within the first 8 h of presentation to the emergency department, 843 lactates and 1019 glucoses were available, respectively. Lactate decreased to 50% of its initial value within 1.5 h (95% CI [0.2–3.6 h]), while glucose halved within 5.6 h (95% CI [5.4–5.7 h]). Also, in the first 8 h after presentation lactate decreases more than glucose in relation to their initial values (lactate 72.6% vs glucose 52.1%). In patients with marked hyperlactatemia after OHCA, lactate decreased expediently while glucose recovered more slowly, whereas arterial pH recovered at a similar rapid rate as lactate. Hospital non-survivors (N = 82) had a slower recovery of lactate (P = 0.002) than survivors (N = 82). The preferential clearance of lactate underscores its role as a prime energy substrate, when available, during recovery from extreme stress.

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