Case No. 2: Status Post Cardiac Arrest

A 19yr old white male, s/p cardiac arrest, now with transtentorial herniation.

As with this case, ECG patterns in the context of acute CNS disease have been primarily associated with ventricular repolarization, i.e. the morphology of the QT segment and T-wave, and the presence of prominent U-waves (not present here). Although little sensitivity or specificity has been accorded to this connection, the phenomenon raises interesting questions of nerocardiac interrelation. Most explicitly, bradycardia as a result of hypervagotonia is often noted in the setting increased intracranial pressure. Yet more difficult to explain are the deep, symmetrical T-wave inversions and prolonged Q-T frequently described as more specific indicators of intracranial pathology. It has been hypothesized that these effects are due to an autonomicaly mediated catocholamine surge causing transient coronary vasospasm and subsequent myocardial ischemia.

The ST segments in this case are of a somewhat novel morphology, perhaps even reminiscent of the scooped out troughs seen as a common Digitalis effect.

This pt. was taken to the OR for withdrawal of ventilatory support and organ donation later in the night.

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3 responses

  1. Hugh

    More on this particular case might be helpful–any underlying conditions that precipitated this event?
    Thanks

    October 18, 2010 at 11:05 am

  2. A very appropriate question. This pt was found by his girlfriend following a reportedly unwitnessed cardiac arrest; an extensive drug history was present, but toxicology revealed only the presence of alcohol at the time of admission. Similarly, there was no history of recent complaints or illness, nor any evidence of trauma. Digested blood was suctioned from the pt’s airway during the intubation effort but the hemoglobin and hematocrit were within normal limits on arrival in the ICU. In short, no obvious proximal cause stands out. In light of this pt’s diffuse hypoxic brain injury and rapidly deteriorating pulmonary status during ICU course, however, it could be argued that an aspirational event may have occurred while the pt was intoxicated, leaving him unable to clear his own airway.

    October 18, 2010 at 7:18 pm

  3. VinceD

    What really caught my attention on this ECG wasn’t so much the ST and T-wave changes but the widening of the second half of the QRS complexes followed by what look like epsilon waves. If you didn’t include the information about herniation I would swear the cardiac arrest was secondary to arrhythmogenic right ventricular dysplasia. I have no clue what the connection could be; maybe related to elevated circulating catecholamines?

    May 27, 2011 at 10:21 am

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