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He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder. Uncontrolled coronary spasm may be associated with serious arrhythmias , including cardiacarrest ( Looi et al — Postgrad Med, 2012 ; Tan et al — Eur Heart J Case Rep, 2018 ; Chevalier et al — JACC, 1998 ; Rodriguez-Manero — EP Europace, 2018 ).
Patient had an unwitnessed cardiacarrest without bystander CPR performed. Initial vitals show hypertension (175/85), Atrial Fibrillation with RVR as seen in Figure 1 , hypercapnia (99mmHg), and SPO2 of 100%. Figure 2 : This rhythm shows a sinus bradycardia at a rate between 30 and 40bpm.
There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. If cardiacarrest from hypokalemia is imminent (i.e., mEq/L, from 1.9
Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. This patient is actively dying from a left main coronary artery OMI and cardiacarrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiacarrest.
Written by Jesse McLaren An 80 year old patient with diabetes/hypertension/ cirrhosis had a recent increase in candesartan for their hypertension, and was also on spirolactone and nadolol. Theres no prior ECG to compare - but the bradycardia, prolonged PR and peaked T waves could all be from hyperkalemia.
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