Case report: Rapid defibrillation after out-of-hospital cardiac arrest

Cardiology Review® Online, May 2004, Volume 21, Issue 5

A previously healthy 60-year-old white man collapsed suddenly while umpiring a softball game. The witnessed arrest resulted in a prompt emergency 911 call, with early arrival of a police officer. The patient was pulseless, and an automatic external defibrillator was attached, showing ventricular fibrillation. The patient received a shock 2.9 minutes after the 911 call was received, and sinus rhythm was restored. The patient was intubated onsite and transferred to the hospital. He received prophylactic lidocaine.

On arrival at the coronary care unit, the patient’s blood pressure was 138/80 mm Hg, with a pulse of 72 beats per minute. He was intubated but alert and moved all of his extremities on command. The findings of the cardiac and pulmonary examinations were normal. The patient’s baseline laboratory examination was normal, with the exception of an increased creatine kinase level of 372 U/L and a total cholesterol level of 216 mg/dL. His high-density lipoprotein cholesterol was 39 mg/dL, his low-density lipoprotein cholesterol was 136 mg/dL, and his triglycerides were 206 mg/dL. His troponin I level was undetectable.

An electrocardiogram showed ST-segment depression in the anterolateral leads. A coronary angiogram showed severe three-vessel disease, including a 60% to 70% stenosis of the left main artery. A transthoracic echocardiogram showed anteroseptal hypokinesis, with an ejection fraction of 50%. The patient was extubated without complications shortly after returning to the coronary care unit.

The patient received three-vessel coronary artery bypass graft surgery without complications 6 days after hospital admission. An implantable cardioverter-defibrillator (ICD) was placed 4 days later. The patient was discharged 12 days after admission and returned home independently without obvious physical or mental impairment, other than the slight disability to be expected from the surgical procedure.

Three years after the cardiac arrest, the patient has completed cardiac rehabilitation and is taking simvastatin, metoprolol, and ramipril. He has no symptoms of heart failure and experiences no persistent angina. He has lost 15 lbs and jogs 5 days a week for nearly 30 minutes. He returned to his previous job and umpires softball games at night. He has received interrogation of his ICD every 3 months without detection of subsequent ventricular arrhythmias.