Sudden Cardiac Death: Managing Periods of High Risk in Acute Coronary Syndromes

May 03, 2012   |  Rohit Mehta, MD, FACC
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A 66 year old man with no prior medical history presented to the hospital with chest discomfort that began 3 hours prior to hospital presentation. In the field, EMS transmitted an ECG to the emergency department (Figure 1) that demonstrated ST-elevation in the anterior distribution. He had ventricular tachycardia en route that required defibrillation and a short course of cardiopulmonary resuscitation. Aspirin, intravenous heparin, clopidogrel and IV amiodarone was administered en route.

Figure 1
Figure 1: Sudden Cardiac Death: Managing Periods of High Risk in Acute Coronary Syndromes
The patient was taken directly to the cardiac catheterization laboratory and was noted to have 100% proximal left anterior descending (LAD) occlusion. He underwent emergent percutaneous intervention to the LAD and was noted to have an ejection fraction of 15% by ventriculography. He was taken to the coronary care unit (CCU) for post-procedural care. Two hours post procedure, while clinically stable and asymptomatic, he had an episode of spontaneous ventricular fibrillation, which required external defibrillation.

Based on the above information, the next step in care would be:

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