Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously

This case is of a 76-year-old man with a known history of hypertension, type 2 diabetes mellitus, and ischemic heart disease, who presented to our department with chest pain and palpitations. His electrocardiogram showed a ventricular tachycardia (VT), but fortunately our patient was hemodynamically stable. A trial of adenosine was given to convert the patient’s heart back to sinus rhythm, but was unsuccessful and the rhythm remained as VT. Soon after, the patient suddenly became hemodynamically unstable as his blood pressure acutely declined; thus, the decision to perform a direct current cardioversion was taken. Bearing in mind that the patient was still awake, he was given 10 mg of intravenous etomidate as a pre-procedural sedative. During the time it took to prepare for the procedure, the patient’s rhythm reverted from VT to a regular sinus rhythm, raising his blood pressure back to normal and achieving hemodynamic stablility, negating the need of any electrical or chemical cardioversion. Our patient was then handed over to the cardiology team for an emergency percutaneous coronary intervention procedure and an implantable cardioverter-defibrillator procedure, both of which were successful. Etomidate was used in this case for the purpose of sedation, and as luck would have it, it seems that it had also incidentally reverted the arrhythmia back to normal.

Percutaneous coronary intervention

This chapter covers percutaneous coronary intervention. It starts with the history of the procedure, indications, and techniques for imaging the lesion, and describes different systems of lesion classification. The equipment required for percutaneous coronary intervention, including guiding catheters, angioplasty guide wires, angioplasty balloons, and intracoronary stents (drug-eluting stents, bioabsorbable scaffolds, etc.) are all covered. The percutaneous coronary intervention procedure is then explained. Intravascular ultrasound is compared and contrasted to optical coherence tomography. Antiplatelet and anticoagulant therapies are described in detail, and finally specific techniques in complex PCI are covered.

Case Report: USE OF INTRA-AORTIC BALLOON PUMP (IABP) IN HIGH-RISK PERCUTANEOUS CORONARY INTERVENTION PROCEDURE

Intra-aortic balloon pump (IABP) is often used in patients who undergo high risk percutaneous coronary intervention (PCI) procedures, particularly if associated with hemodynamic impairment. However, this device is still underused in this center. In this case report, a 65-year old male patient with triple vessel disease (chronic total occluded left anterior descending artery-LAD, and significant stenoses of left circumflex and right coronary arteries), low ejection fraction and preprocedure blood pressure, was reported to have IABP support applied before PCI. The intervention to penetrate the occluded LAD was not success. After procedure, the patient was observed in intensive care unit. Weaning of IABP was performed after about 30 hours usage, without complication.