A 52-Year-Old Male Presented With Cardiac Arrest After Suddenly Collapsing at Work
A 52-year-old male presented with cardiac arrest after suddenly collapsing at work. An AED was placed and recommended shocking. He received two shocks, CPR was initiated, and 911 was called. EMS arrived 5 minutes later. The initial rhythm was ventricular fibrillation. He received two more shocks, 3 doses of epinephrine, 1 dose of vasopressin, 300 mg of amiodarone, and after approximately 25 minutes had recovery of spontaneous rhythm. On arrival in the ED he was hemodynamically stable.
- BP 130/80 mmHg, HR 95 bpm, RR 20, intubated
- Lungs: clear
- Cardiac: regular rate and rhythm, normal S1S2, no murmurs
- Abdomen: soft, non-tender, minimal bowel sounds
- Extremities: no edema
- Neuro: pupils were minimally reactive, no purposeful movement.
ECG NSR, QTc 550 msec, No Q waves, 0.5 mm ST depression in V5 and V6
Emergent coronary angiography was performed, which showed mild luminal irregularities without significant stenosis, with an LVEF of 40% and mild global hypokinesis.
- BUN/Creatinine 15 mg/dl 0.8 mg/dL
- Na 140 mmol/L
- K 4.0 mmol/L
- Hgb 15.9 g/dl wbc 11.3 10e9/L
Initial Cardiac Markers
- CK 560 U/L
- MB 15 ng/mL
- TnI 0.25 ng/ml
Peak, 18 hours later
- CK 1246 U/L
- MB 37 ng/ml
- TnI 1.2 ng/ml
He was treated with induced hypothermia and four days later was extubated with full neurologic recovery.
The most likely diagnosis is: