Sudden cardiac arrest in hypertrophic cardiomyopathy with dynamic cavity obstruction: The case for a decatecholaminisation strategy. (February 2018)

• Record Type: Journal Article
• Authors: Balan, Cosmin; Wong, Adrian View-Kim
• Is Part Of: Journal of the Intensive Care Society. Volume 19:Number 1(2018:Feb.)
• Page Start: 69
• Page End: 75
• Publication Date: 2018-02
• Subjects: Hypertrophic cardiomyopathy -- mid-ventricular obstruction -- sudden cardiac arrest -- catecholamines -- echocardiography; Critical care medicine -- Periodicals; Intensive care units -- Periodicals; 616.028
• DOI: 10.1177/1751143717732729
• Languages: English
• ISSNs: 1751-1437

Abstract

Catecholamines are entrenched in the management of shock states. A paradigm shift has pervaded the critical care arena in recent years acknowledging their propensity to cause harm and fuel a 'death-spiral'. We present the case of a 21-year-old male following a witnessed out-of-hospital cardiac arrest who received high-quality cardiopulmonary resuscitation and standard advanced life support for refractory ventricular fibrillation until return of spontaneous circulation after 70 min. Early post-admission echocardiography revealed severe diffuse sub-basal left ventricular hypertrophy with dynamic mid-cavity obstruction and akinetic apical pouching. Within this context, a decatecholaminised strategy comprising a beta-blocker was used to augment the left ventricular end-diastolic volume and attain cardiovascular stability.