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Background:Epicardial patch defibrillators (EPDs) were commonly implanted in the 1990s for secondary prevention of sudden cardiac death. Circulation, Volume 150, Issue Suppl_1 , Page A4139677-A4139677, November 12, 2024. Despite being largely obsolete, some EPDs remain in patients and can cause late complications.
She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction.
That occurs in right heart failure and constrictive pericarditis. Constrictive pericarditis is an important cause for Kussmaul sign or inspiratory increase in jugular venous pressure. On the other hand, the Y descent is very prominent in constrictive pericarditis, and it is known as Friedreich’s sign.
It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism.
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