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Washington University Experience | VASCULAR | Infarct - Remote | 10A0 Case 10 History
Case 10 History ---- This patient was a 67-year-old man with a history of diabetes, hypertension, hyperlipidemia, coronary artery disease (status post coronary artery bypass grafting in 2000), peripheral vascular disease (status post femoral-popliteal artery bypass grafting in 2001), and prior (4 years) stroke resulting in lateral medullary syndrome with residual left hemiparesis. He was admitted to an outside hospital for weakness and possible bowel and bladder dysfunction. During a lumbar puncture procedure, he developed respiratory distress, was intubated for airway protection, and transferred to BJH where dopamine was administered for pressor support (mean arterial pressure was 55). Electrocardiogram showed bigeminy that evolved into pulseless electrical activity. The patient coded three times (PEA arrest) over two hours and received five defibrillating shocks for ventricular tachycardia. He developed renal and hepatic failure and was placed on CVVHD. Laboratory values established myocardial infarction. The patient once again became bradycardic and hypotensive and expired.
