Anesthesia Management of a Patient with a History of Cardiac Arrest during Two Operations

Purpose: A case of loperamide-induced recurrent torsades de pointes is reported to raise awareness of an increasingly common phenomenon that could be encountered by medical providers during the current opioid epidemic. Summary: A 40 year-old-man with a prior history of opioid abuse who presented to the emergency department after taking up to 100 tablets of loperamide 2 mg daily for 5 years to blunt opioid withdrawal symptoms and was subsequently admitted to the intensive care unit for altered mental status and hyperthermia. The patient had prolonged QTc and 2 episodes of torsades de pointes (TdP) that resulted in cardiac arrest with return of spontaneous circulation. He was managed with isoproterenol, overdrive pacing, and methylnatrexone with no other events of TdP or cardiac arrest. Conclusion: A 40-year-old male who developed torsades de pointes from loperamide overdose effectively treated with overdrive pacing, isoproterenol, and methylnatrexone.

Download Full-text

Sudden cardiac arrest in 15-year-old girl. Could it be avoided?

In a good rythm ◽

10.5604/01.3001.0011.6500 ◽

2018 ◽

Vol 1 (46) ◽

pp. 43-48

Author(s):

Maria Posadowska ◽

Maria Miszczak-Knecht ◽

Alicja Mirecka-Rola ◽

Katarzyna Bieganowska

Keyword(s):

Cardiac Arrest ◽

Hypertrophic Cardiomyopathy ◽

Cardiac Death ◽

Sudden Cardiac Arrest ◽

Postmortem Examination ◽

Cardiac Care ◽

Related Family ◽

Asymptomatic Patients ◽

History Of ◽

Genetically Determined

We present a case of a 15-year-old girl after sudden cardiac arrest because of ventricular fibrillation. Hypertrophic cardiomyopathy was diagnosed. Family history of patient was positive – her uncle (mother’s brother) died suddenly at the age of 21, postmortem examination showed hypertrophic cardiomyopathy. The deceased man’s family was not under cardiac care. The presented case proves, that due to genetically determined cardiac diseases such as cardiomyopathies and channelopathies, all related family members should be examined cardiologically. Diagnosis of the disease in asymptomatic patients would allow the implementation of treatment and reduce the risk of a sudden cardiac arrest / sudden cardiac death.

Download Full-text

Preclinical short QT syndrome models: studying the phenotype and drug-screening

EP Europace ◽

10.1093/europace/euab214 ◽

2021 ◽

Author(s):

Xuehui Fan ◽

Guoqiang Yang ◽

Jacqueline Kowitz ◽

Firat Duru ◽

Ardan M Saguner ◽

...

Keyword(s):

Cardiac Arrest ◽

Family History ◽

Three Dimensional ◽

Induced Pluripotent Stem Cell ◽

Experimental Models ◽

Short Qt Syndrome ◽

Pathophysiological Mechanisms ◽

History Of ◽

Qt Syndrome ◽

European Society Of Cardiology

Abstract Cardiovascular diseases are the main cause of sudden cardiac death (SCD) in developed and developing countries. Inherited cardiac channelopathies are linked to 5–10% of SCDs, mainly in the young. Short QT syndrome (SQTS) is a rare inherited channelopathy, which leads to both atrial and ventricular tachyarrhythmias, syncope, and even SCD. International European Society of Cardiology guidelines include as diagnostic criteria: (i) QTc ≤ 340 ms on electrocardiogram, (ii) QTc ≤ 360 ms plus one of the follwing, an affected short QT syndrome pathogenic gene mutation, or family history of SQTS, or aborted cardiac arrest, or family history of cardiac arrest in the young. However, further evaluation of the QTc ranges seems to be required, which might be possible by assembling large short QT cohorts and considering genetic screening of the newly described pathogenic mutations. Since the mechanisms underlying the arrhythmogenesis of SQTS is unclear, optimal therapy for SQTS is still lacking. The disease is rare, unclear genotype–phenotype correlations exist in a bevy of cases and the absence of an international short QT registry limit studies on the pathophysiological mechanisms of arrhythmogenesis and therapy of SQTS. This leads to the necessity of experimental models or platforms for studying SQTS. Here, we focus on reviewing preclinical SQTS models and platforms such as animal models, heterologous expression systems, human-induced pluripotent stem cell-derived cardiomyocyte models and computer models as well as three-dimensional engineered heart tissues. We discuss their usefulness for SQTS studies to examine genotype–phenotype associations, uncover disease mechanisms and test drugs. These models might be helpful for providing novel insights into the exact pathophysiological mechanisms of this channelopathy and may offer opportunities to improve the diagnosis and treatment of patients with SQT syndrome.

Download Full-text

Abstract 223: Association Between Covid-19 Pandemic Related Anxiety and Advanced Care Planning Desire in Cardiac Arrest Survivors

Circulation ◽

10.1161/circ.142.suppl_4.223 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Benjamin J Meyer ◽

Samuel Jacobson ◽

David Roh ◽

Soojin Park ◽

Jan Claassen ◽

...

Keyword(s):

New York ◽

New York City ◽

Cardiac Arrest ◽

Generalized Anxiety ◽

Advanced Directives ◽

Health Related ◽

History Of ◽

Direct And Indirect Impacts ◽

Indirect Impacts ◽

Desire To Change

Introduction: Patients with cardiovascular disease conditions are at high risk for direct and indirect impacts of COVID-19 on morbidity and mortality. In light of this, we aimed to assess the extent to which COVID-19-related anxiety in patients with a history of cardiac arrest (CA) correlates with the desire to change or discuss advanced directives. Methods: Between May 15-28, 2020, a month after the New York City (NYC) COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and other survivorship dimensions. COVID-19-related anxiety was measured by the Generalized Anxiety Disorder-3 scale, which asks how often respondents felt (1) anxious, (2) unable to stop worrying, and (3) excessively worried over two weeks, and was keyed to the COVID-19 pandemic. Desire to discuss or to change financial and/or health-related advanced directives were reported on a yes-or-no basis. Results: 100 approached, 69 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). A majority, 58 of 69 (84%), had no COVID-19 symptoms and/or were not tested. Only 12 of the 69 respondents (17%) showed interest in discussing or changing advanced directives. There were no significant differences in the age, sex, race, or COVID-19 symptoms status between those who showed desire versus those who did not. Desire to change advance directives was significantly associated with increased COVID-19-related anxiety (OR 1.5, CI 95% [1.2-1.9] p<0.002). Conclusions: In CA survivors, a desire to change financial or healthcare-related advanced directives during the COVID-19 outbreak was associated with increased pandemic-related anxiety. The causality and directionality of this relationship require further, qualitative study.

Download Full-text

Disseminated Intravascular Coagulation and Malignancy: A Case Report and Literature Review

Case Reports in Oncological Medicine ◽

10.1155/2020/9147105 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Sumit Sohal ◽

Akhilesh Thakur ◽

Aleena Zia ◽

Mina Sous ◽

Daniela Trelles

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Cardiac Arrest ◽

Disseminated Intravascular Coagulation ◽

Limb Ischemia ◽

Symptomatic Treatment ◽

Malignant Cells ◽

Intravascular Coagulation ◽

Fluid Analysis ◽

History Of

Disseminated Intravascular Coagulation (DIC) is a disorder of coagulation which is commonly seen as a complication of infections, traumas, obstetric diseases, and cancers especially hematological and rarely solid cancers. DIC may rarely be the presenting feature of an undiagnosed malignancy. It may present in the form of different phenotypes which makes its diagnosis difficult and leads to high mortality. The treatment comprises supportive, symptomatic treatment and removal of the underlying source. Here, we present a patient with history of being on warfarin for atrial fibrillation and other comorbidities who presented with elevated INR of 6.3 and increasing dyspnea on exertion. Over the course of her stay, her platelet counts started dropping with a concurrent decrease in fibrinogen levels. She eventually developed pulmonary embolism, followed by stroke and limb ischemia, which was indicative of the thrombotic phenotype of DIC. Her pleural fluid analysis showed huge burden of malignant cells in glandular pattern suggestive of adenocarcinoma and was started on heparin drip. However, the patient had cardiac arrest and expired on the same day of diagnosis.

Download Full-text

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.

Download Full-text

The clinical history of cardiac arrest and recovery of anaesthetized hypothermic rats, and their reproduction

Resuscitation ◽

10.1016/0300-9572(72)90064-0 ◽

1972 ◽

Vol 1 (1) ◽

pp. 51-60 ◽

Cited By ~ 6

Author(s):

H. Hillman ◽

Joan Loupekine ◽

Pauline Fullbrook

Keyword(s):

Cardiac Arrest ◽

Clinical History ◽

History Of

Download Full-text

Sudden Cardiac Arrest during Adenotonsillectomy in a Patient with Subclinical Duchenne's Muscular Dystrophy

Ear Nose & Throat Journal ◽

10.1177/014556139307200206 ◽

1993 ◽

Vol 72 (2) ◽

pp. 130-131 ◽

Cited By ~ 8

Author(s):

Nick C. Benton ◽

Robert A. Wolgat

Keyword(s):

Cardiac Arrest ◽

Muscular Dystrophy ◽

General Anesthesia ◽

Case Reports ◽

Sudden Cardiac Arrest ◽

Elevated Serum ◽

Serum Creatine Kinase ◽

Strong Family History ◽

History Of ◽

Duchenne's Muscular Dystrophy

We describe a four-year-old boy of Indian descent who had elective adenotonsillectomy for chronic sore throat and partial airway obstruction. About 10 minutes into the procedure, the patient suddenly developed cardiac asystole. After prolonged cardiac resuscitation, recovery was achieved. No permanent neurologic deficits resulted. The child was later found to have a strong family history of Duchenne's muscular dystrophy (DMD) and an elevated serum creatine kinase level documented since shortly after birth. We reviewed several case reports substantiating the risk for cardiac arrest during general anesthesia in DMD patients, and we concluded that DMD is a little-known risk for cardiac arrest during general anesthesia. The otolaryngologist must be aware of this potential complication, because tonsillectomy and adenoidectomy are commonly indicated for children at an age when DMD may be subclinical.

Download Full-text

Systematic review of the relationship between comorbidity and out-of-hospital cardiac arrest outcomes

BMJ Open ◽

10.1136/bmjopen-2019-031655 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031655 ◽

Cited By ~ 4

Author(s):

David Majewski ◽

Stephen Ball ◽

Judith Finn

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Current Evidence ◽

Cochrane Library ◽

Neurological Outcomes ◽

Statistical Heterogeneity ◽

Comorbidity Burden ◽

History Of ◽

The Impact ◽

Hospital Cardiac Arrest

ObjectivesTo assess the current evidence on the effect pre-arrest comorbidity has on survival and neurological outcomes following out-of-hospital cardiac arrest (OHCA).DesignSystematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Data sourcesMEDLINE, Ovid Embase, Scopus, CINAHL, Cochrane Library and MedNar were searched from inception to 31 December 2018.Eligibility criteriaStudies included if they examined the association between prearrest comorbidity and OHCA survival and neurological outcomes in adult or paediatric populations.Data extraction and synthesisData were extracted from individual studies but not pooled due to heterogeneity. Quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale.ResultsThis review included 29 observational studies. There were high levels of clinical heterogeneity between studies with regards to patient recruitment, inclusion criteria, outcome measures and statistical methods used which ultimately resulted in a high risk of bias. Comorbidities reported across the studies were diverse, with some studies reporting individual comorbidities while others reported comorbidity burden using tools like the Charlson Comorbidity Index. Generally, prearrest comorbidity was associated with both reduced survival and poorer neurological outcomes following OHCA with 79% (74/94) of all reported adjusted results across 23 studies showing effect estimates suggesting lower survival with 42% (40/94) of these being statistically significant. OHCA survival was particularly reduced in patients with a prior history of diabetes (four out of six studies). However, a prearrest history of myocardial infarction appeared to be associated with increased survival in one of four studies.ConclusionsPrearrest comorbidity is generally associated with unfavourable OHCA outcomes, however differences between individual studies makes comparisons difficult. Due to the clinical and statistical heterogeneity across the studies, no meta-analysis was conducted. Future studies should follow a more standardised approach to investigating the impact of comorbidity on OHCA outcomes.PROSPERO registration numberCRD42018087578

Download Full-text

Hippocampal Necrosis in a Cat from Australia

Case Reports in Veterinary Medicine ◽

10.1155/2014/306789 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Carl Adagra ◽

Susan Amanda Piripi

Keyword(s):

Cardiac Arrest ◽

Behavioural Change ◽

Postmortem Examination ◽

Intravenous Fluid ◽

Inferior Temporal Gyrus ◽

Focal Seizures ◽

History Of ◽

Hippocampal Necrosis

This paper reports findings from a feline case of hippocampal necrosis. A seven-year-old neutered female cat was seen with a history of behavioural change followed by complex focal seizures. The cat was severely pyrexic on presentation and anisocoria was present. It was treated with cooling, intravenous fluid, and phenobarbitone administration which was later changed to levetiracetam. An MRI was performed and revealed findings of a hypointense T1 and hyperintense T2 signal in the hippocampus and inferior temporal gyrus with mild gadolinium uptake, findings which were consistent with previous cases of hippocampal necrosis. The cat was witnessed to vomit and aspirate 24 hours after diagnosis leading to cardiac arrest and death. Postmortem examination revealed a subacute degenerative encephalopathy involving the hippocampus.

Download Full-text