Point-of-Care Ultrasound Diagnosis of Right Ventricular Rupture Post Cardiac Arrest After Thrombolysis in Myocardial Infarction

摘要

An 81-year-old male was referred by his general practitioner with a troponin-T of 153 nanograms per liter (ng/L) (reference range 5 ng/L) and chest pain ongoing for 13 hours on arrival. Initial electrocardiogram showed 7-millimeter anterior ST elevation in leads V2-5. The case was discussed with cardiology at the nearest tertiary care center and plans were arranged for the patient’s transfer for percutaneous coronary intervention. Thrombolysis was withheld due to a known abdominal aortic aneurysm and a suspicious renal mass under investigation. While awaiting transfer, the patient suffered a ventricular tachycardia arrest, and cardiopulmonary resuscitation (CPR) was commenced. Point-of-care echocardiogram was performed, showing a hypokinetic myocardium. After four rounds of CPR, thrombolysis was given as a last resort. Repeat point-of-care echocardiography demonstrated irrecoverable injury; therefore, CPR was discontinued (Video).