Sunday, September 23, 2012

The Other Cause of Sudden Cardiac Arrest

All too often we associate sudden cardiac arrest (SCA) with tachyarrhythmias post-infarction.  Sometimes, there is another cause for post-infarction SCA that is forgotten:

Click image to enlarge
The above EKG was acquired four days following an anterior myocardial infarction during a pre-discharge submaximal (modified Bruce) stress test after walking 1.3 MPH for 5 minutes.  Note the bifascicular block (RBBB, LAFB) and lack of PR segment prolongation (with the exception of the PAC) just before the event, suggesting an infra-Hisian location of the eventual AV block.

Needless to say, the patient's discharge was postponed.    (We're still waiting word from the doctor who ran the above test as to the condition of his underwear.)



Michael G. Katz, M.D. said...

Code brown was paged overhead.

Jason E. Roediger, CCT,CRAT said...

Dr. Wes,

Could it be postulated that the PAC initiated the ventricular asystole and A-V block due to "phase 4" phenomenon in the posterior fascicle?