Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

Abstract Background Myxedema coma, which occurs due to hypothyroidism, is a rare and life-threatening condition. Some patients have hemodynamic dysfunction, which consequently leads to cardiac arrest. The rarity of this condition makes it difficult to determine the cause of cardiac arrest. It is important to diagnose myxedema coma based on clinical findings, including physical examination and laboratory parameters. We present a case of undiagnosed and untreated hypothyroidism that initially caused myxedema coma and then led to cardiac arrest. Case presentation A 56-year-old woman who had no medical history was transferred to our hospital for the management of return of spontaneous circulation due to sudden cardiac arrest. Findings of laboratory tests revealed that she had hypothyroidism. On physical examination, she was found to have a puffy face, thin eyebrows, and severe systemic non-pitting edema. Therefore, the patient was clinically diagnosed with myxedema coma, which was the cause of cardiac arrest. She was treated with thyroid hormone and hydrocortisone, resulting in improvement in her general condition, except for the neurological dysfunction. Conclusions This case suggests that myxedema coma is caused by undiagnosed and untreated hypothyroidism, leading to sudden cardiac arrest. Our findings are useful in the differential diagnosis of hypothyroidism based on characteristic physical examination findings. Clinicians should be aware of the differential diagnosis of myxedema coma based on findings from physical examination and laboratory testing of thyroid function, and the treatment should be started immediately.

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Sudden Cardiac Arrest During Computed Tomography Examination: Clinical Findings and “Dense Abdominal Veins” on Computed Tomography

Journal of Computer Assisted Tomography ◽

10.1097/00004728-200301000-00017 ◽

2003 ◽

Vol 27 (1) ◽

pp. 93-97 ◽

Cited By ~ 12

Author(s):

Sheung-Fat Ko ◽

Shu-Hang Ng ◽

Min-Chi Chen ◽

Tze-Yu Lee ◽

Chung-Cheng Huang ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

Clinical Findings

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Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001084 ◽

2021 ◽

pp. 1-6

Author(s):

Chuenruthai Angkoontassaneeyarat ◽

Chaiyaporn Yuksen ◽

Chetsadakon Jenpanitpong ◽

Pemika Rukthai ◽

Marisa Seanpan ◽

...

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Health Care Providers ◽

Care Providers ◽

Chest Compressions ◽

Threatening Condition ◽

Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

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Out-of-Hospital Resuscitation: Have We Gone Too Far?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004180 ◽

2006 ◽

Vol 21 (6) ◽

pp. 445-450 ◽

Cited By ~ 4

Author(s):

Corita Grudzen

Keyword(s):

Cardiac Arrest ◽

Prehospital Care ◽

Sudden Cardiac Arrest ◽

Hospital Setting ◽

The United States ◽

Spontaneous Circulation ◽

Emergency Medical ◽

Clinical Scenarios ◽

Life Sustaining Treatment ◽

Future Policy

AbstractAmericans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints.

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T-wave inversion in the precordial leads: сardiac and non-cardiac causes

Kardiologiia ◽

10.18087/cardio.2020.5.n668 ◽

2020 ◽

Vol 60 (5) ◽

pp. 136-145

Author(s):

I. R. Tsoy ◽

I. P. Kolos

Keyword(s):

Pulmonary Embolism ◽

Differential Diagnosis ◽

Anterior Wall ◽

Left Ventricular ◽

Arrhythmogenic Cardiomyopathy ◽

Cardiac Memory ◽

T Wave ◽

Wave Inversion ◽

Threatening Condition ◽

Life Threatening

The T-wave inversion (TWI) is a common electrocardiographic finding. Causes for TWI are numerous and sometimes TWI may appear in life-threatening conditions. The aim of this review was to provide an up-to-date analysis of TWI, including i) definition and prevalence; ii) causes, and iii) differential diagnosis in benign TWI, reversible myocardial ischemia of the left ventricular anterior wall; takotsubo cardiomyopathy; subarachnoid hemorrhage; pulmonary embolism; right ventricular arrhythmogenic cardiomyopathy; and “cardiac memory”. The review presents practical electrophysiological criteria, which allow suspecting in time a life-threatening condition to choose an up-to-date treatment.

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Abstract 246: Therapeutic Hypothermia Mimicking Peptide Administration During Cardiopulmonary Resuscitation Improved Cardiac Arrest Survival in Swine

Circulation ◽

10.1161/circ.142.suppl_4.246 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Matt Oberdier ◽

Jing Li ◽

Dan Ambinder ◽

Xiangdong Zhu ◽

Sarah Fink ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Venous Blood ◽

Plasma Concentrations ◽

Sudden Cardiac Arrest ◽

The United States ◽

Rapid Onset ◽

Spontaneous Circulation ◽

Control Group ◽

Swine Model

Background: Out-of-hospital sudden cardiac arrest is a leading cause of death in the United States, affecting over 350,000 people per year with an overall survival rate around 10%. CPR, defibrillation, and therapeutic hypothermia are common resuscitation strategies, but hypothermia is difficult to implement timely to achieve survival benefit. A cell-permeable peptide TAT-PHLPP9c has been shown to alter metabolic pathways similar to hypothermia, and decreases the release of two biomarkers, taurine and glutamate, during the high osmotic stress of heart stunning and brain injury in a mouse arrest model. Hypothesis: TAT-PHLPP9c, given during CPR, enhances 24-hour survival in a swine ventricular fibrillation (VF) model. Methods: In 14 (8 controls and 6 treated) sedated, intubated, and mechanically ventilated swine, after 5 min of VF, ACLS with vest CPR and periodic defibrillations was performed. Venous blood samples were collected at baseline, after 2 min of CPR, and at 2 and 30 min after return of spontaneous circulation (ROSC). The animals were survived up to 24 hrs and plasma samples were analyzed for glutamate and taurine in 2 controls and 1 animal given peptide. Results: Three of the control animals had ROSC, but none survived for 24 hrs, while 4 of 6 treated animals achieved neurologically intact survival at 24 hrs (p < 0.02). Compared to baseline, both taurine and glutamate plasma concentrations increased in the control group, but the increase was reduced substantially by the peptide treatment at 30 min after ROSC (Figure). Conclusion: The use of the cooling mimicking peptide TAT-PHLPP9c administered during CPR significantly improved 24-hour survival in this swine model of cardiac arrest. It reduced the increase of cerebral and myocardial metabolic biomarkers, which encourages utilizing a strategy of cell-permeable peptides for intravenous administration for more rapid onset of hypothermia-like salutary effects than are possible with current CPR cooling devices.

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Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

BMJ Case Reports ◽

10.1136/bcr-2020-239697 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239697

Author(s):

Sarah Cheyney ◽

Zachary Field ◽

Jacqueline Kropf ◽

Steve Carlan

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Topical Anaesthetic ◽

Over The Counter ◽

Perimenopausal Woman ◽

Threatening Condition ◽

Life Threatening

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

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Posteclampsia Sudden Cardiac Arrest (SCA): A Rare Etiology

Case Reports in Obstetrics and Gynecology ◽

10.1155/2020/8862839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Nissar Shaikh ◽

Shoaib Nawaz ◽

Arshad Chanda ◽

Seema Nahid ◽

Muhmmad Zubair ◽

...

Keyword(s):

Cardiac Arrest ◽

Magnesium Sulphate ◽

Serum Magnesium ◽

Sudden Cardiac Arrest ◽

Kidney Injury ◽

Spontaneous Circulation ◽

Cardiac Biomarkers ◽

Morbidly Obese ◽

Neurogenic Pulmonary Edema ◽

Normal Range

Eclampsia is associated with high maternal and fetal morbidity and mortality. The mortality in eclampsia is reported to be secondary to cerebrovascular accidents, neurogenic pulmonary edema, or acute kidney injury leading to cardiac arrest. A rarely reported etiology is sudden cardiac arrest (SCA) immediately after the seizure activity. We report a case of morbidly obese multigravida, complicated into postnatal eclampsia developing postseizure SCA due to apnea. Case. A 35-year-old woman in 38 weeks of gestation presented to the women’s hospital emergency with hypertension and proteinuria and had lower section caesarean section under epidural anesthesia and required labetalol infusion. She developed convulsions in the 1st postoperative day, and she was started on magnesium sulphate therapy. After a few minutes, the patient had a 2nd episode of convulsions, apnea, cyanosis, and cardiac asystole requiring cardiopulmonary resuscitation and spontaneous circulation returned in 3 minutes. Her endotracheal intubation was difficult, but we succeeded in the 2nd attempt. She was sedated, ventilated, and required noradrenaline to maintain hemodynamics. Her ECG, echocardiogram, cardiac biomarkers, CT chest/brain, and serum magnesium levels were within normal range. The patient was weaned from vasopressor and ventilator by day 2 and extubated. She became awake; labetalol and magnesium sulphate infusions were stopped by day 3. The patient was transferred to the ward on day 5; from there she was discharged home on day 8 on oral labetalol. She was followed up in an outpatient clinic after 4 weeks and remained comfortable, and blood pressure was controlled with tablet labetalol and repeat echocardiogram was normal. Conclusion. Eclampsia patients can have apnea after seizures, progressing to SCA.

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Life-threatening and major cardiac events during long-distance races: updates from the prospective RACE PARIS registry with a systematic review and meta-analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487320943001 ◽

2020 ◽

pp. 204748732094300

Author(s):

Benoît Gerardin ◽

Paul Guedeney ◽

Anne Bellemain-Appaix ◽

Thomas Levasseur ◽

Hazrije Mustafic ◽

...

Keyword(s):

Cardiac Arrest ◽

Clinical Symptoms ◽

Meta Analysis ◽

Heat Stroke ◽

Sudden Cardiac Arrest ◽

Cardiac Events ◽

Long Distance ◽

Exertional Heat Stroke ◽

Life Threatening ◽

Long Distance Race

Aims Limited data exist regarding the incidence and aetiology of life-threatening events such as major cardiac events or exertional heat stroke during long-distance races. We aimed to provide an updated incidence, etiology and prognosis of life-threatening events during long-distance races. Methods The prospective RACE PARIS registry recorded all life-threatening events/fatal events occurring during 46 marathons, half-marathons and other long-distance races in the Paris area between 2006 and 2016, comprising 1,073,722 runners. Event characteristics were determined by review of medical records and interviews with survivors. Results The incidence of life-threatening events, exertional heat stroke and major cardiac events was 3.35 per 100,000, 1.02 per 100,000 and 2.33 per 100,000, respectively, including 18 sudden cardiac arrests (1.67 per 100,000). The main aetiology of sudden cardiac arrest was myocardial ischaemia (11/18), due to acute coronary thrombosis (6/11), stable atherosclerotic coronary artery disease (2/11), coronary dissection (1/11), anomalous connection (1/11) or myocardial bridging (1/11). A third of participants with ischaemia-related major cardiac events presented with pre-race clinical symptoms. Major cardiac events were more frequent in the case of a high pollution index (6.78 per 100,000 vs. 2.07 per 100,000, odds ratio 3.27, 95% confidence interval 1.12–9.54). Case fatality was low (0.19 per 100,000). Similarly, we report in a meta-analysis of eight long-distance race registries comprising 16,223,866 runners a low incidence of long-distance race-related sudden cardiac arrest (0.82 per 100,000) and fatality (0.39 per 100,000). Death following sudden cardiac arrest was strongly associated with initial asystole or pulseless rhythm. Conclusion Long-distance race-related life-threatening events remain rare although serious events. Better information for runners on the risk of pre-race clinical symptoms, outside air pollution and temperature may reduce their incidence.

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Possible GoLytely-Associated Cardiac Arrest: A Case Report and Literature Review

Journal of Pharmacy Practice ◽

10.1177/0897190019825965 ◽

2019 ◽

Vol 33 (3) ◽

pp. 364-367 ◽

Cited By ~ 2

Author(s):

Yoonsun Mo ◽

Shiv Gandhi ◽

Jose Orsini

Keyword(s):

Cardiac Arrest ◽

Abdominal Pain ◽

Sudden Cardiac Arrest ◽

Lower Abdominal Pain ◽

The Past ◽

Life Threatening ◽

History Of ◽

Artery Disease ◽

Possible Cause

Purpose: To report a case of sudden cardiac arrest possibly associated with the administration of GoLytely® (polyethylene glycol 3350 and electrolytes). Summary: A 60-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presented to the emergency department with complaints of constipation and lower abdominal pain over the past week, and the inability to urinate over the past day. The patient had received GoLytely as treatment to alleviate symptoms of constipation and abdominal pain. However, several hours after administration of the bowel prep solution, the patient suffered an episode of cardiac arrest. After ruling out other possible etiologies, GoLytely was suspected as a possible cause of cardiac arrest. The patient had suffered an anoxic brain injury and remained intubated and unconscious until he eventually expired, 20 days after the event. Conclusion: Although GoLytely appears to be a safe agent with fewer side effects, clinicians need to be mindful of potential life-threatening adverse events following GoLytely administration and monitor patients closely during and after administration.

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Cardiac Arrest in the Airport Revealing Cocaine Body Packing: A Case Report

Case Reports in Medicine ◽

10.1155/2019/6183154 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Dabor Resiere ◽

Hossein Mehdaoui ◽

Bruno Megarbane

Keyword(s):

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

Flight Attendants ◽

Emergency Physicians ◽

Body Packing ◽

Charles De Gaulle ◽

Cross Border ◽

Cardiac Symptoms ◽

Life Threatening ◽

De Gaulle

Ingestion of large amounts of cocaine packages is a well-known method for cross-border transportation. Intestinal obstruction and life-threatening sympathomimetic toxidrome including seizures, ventricular dysrhythmia, and cardiac arrest resulting from the rupture of cocaine packages may occur. Here, we report a case of a 34-year-old pregnant woman who had a sudden cardiac arrest while waiting for her bags at Paris-Charles de Gaulle Airport, France. According to the flight attendants, the patient travelled from Brazil and complained of abdominal pain during the flight. After resuscitation, the patient presented sustained tachycardia and convulsions suggesting cocaine overdose caused by body packing. Once admitted to the hospital, laparotomy was performed allowing the extraction of 50 cocaine packages. Cardiac symptoms were attributed to the rupture of five of the packages. Prehospital and emergency physicians need to be aware of the possibility of cocaine overdose by body packing in patients presenting sudden cardiac arrest in airports.

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