Circulation, Vol 80, 1675-1680, Copyright © 1989 by American Heart Association
M Luu, WG Stevenson, LW Stevenson, K Baron and J Walden
To define the mechanisms of unexpected cardiac arrest in advanced heart
failure, we reviewed the causes of cardiac arrest as established from
electrocardiographic monitoring and from clinical and autopsy data in
patients hospitalized for cardiac transplantation evaluation and management
of advanced heart failure (mean left ventricular ejection fraction, 0.18
+/- 0.08) who were stable while on vasodilator and diuretic therapy such
that hospital discharge to home was anticipated. Twenty-one cardiac arrests
occurred in 20 of 216 (9%) such patients during a 4-year period. Heart
failure was due to coronary artery disease with prior myocardial infarction
in 13 patients and nonischemic cardiomyopathy in seven patients. The rhythm
at the time of arrest was severe bradycardia or electromechanical
dissociation (BA/EMD) in 13 (62%) patients. The precipitating cause of the
BA/EMD arrest was coronary artery thrombosis or embolism in two patients,
pulmonary embolism in one patient, hyperkalemia in two patients, and
unexplained hypoglycemia in one patient. In seven of 13 (54%) patients, a
precipitating cause of the bradycardia arrest could not be established.
Only eight of 21 (38%) arrests were due to ventricular tachycardia or
fibrillation (VT/VF), and all occurred in patients with prior myocardial
infarction (p = 0.02 vs. BA/EMD arrests). Two VT/VF arrests were due to
acute or recent infarction, and one patient had hyperkalemia. The patients
who suffered a BA/EMD arrest were similar to those who had a VT/VF arrest
in age, ventricular arrhythmia history, ventricular function, and serum
potassium levels. Serum sodium levels were lower in patients with BA/EMD
arrests (129 +/- 3 vs. 133 +/- 4 meq/l, p = 0.025).(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Diverse mechanisms of unexpected cardiac arrest in advanced heart failure
Department of Medicine, UCLA School of Medicine.
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