Casos

Sudden acute cardiac arrest in elderly man

Dr. Raimundo Barbosa Barros
Dr. Raimundo Barbosa Barros
Brazil

Case presentation

Caucasian man, 76 years old, referred to the emergency care unit on April 21, 2017. He arrived at the unit convulsing, with diagnostic hypothesis of acute myocardial infarction, complicated with cardiac arrest.

Physical Examination:

Patient brought in ambulance for stabilization at ER. Family member reports that arrived home and encountered patient sweating with psychomotor agitation, moaning, and precordial pain. Upon arriving, paramedics determined that patient was hypoxemic and with inaudible blood pressure. Transported to the ER, patient arrived with respiratory failure – gasping. It was performed orotracheal intubation, escalating to cardiorespiratory arrest at pulseless electrical activity. Reanimation maneuvers with spontaneous circulation return during a total of 5 (3-2-2-2-2) cardiorespiratory arrest cycles and administration of adrenaline, bicarbonate and crystalloids, and noradrenaline. We are hospitalizing patient. We don’t have a mechanical ventilator. ECG showed ST segment elevation in aVR lead and diffuse ST segment depression.

We performed ECG-2, laboratory and percutaneous cineangiography and biventricular angiography. This patient died in the hemodynamics room soon after procedure.

Questions

  1. Which is the etiology of cardiac arrest?
  2. Which is the ECG-1 diagnosis?
  3. Which is the ECG-2 diagnosis?

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Auspicios Institucionales
  • Sociedad Argentina de Cardiología
  • Federación Argentina de Cardiología
  • SIAC
  • SADEC
  • Asociación Argentina de Cardiología
  • Latin American Heart Rhythm Society
  • Fundación Barceló - Facultad de Medicina