RESUMO
We present the case of an elderly female who presented to the emergency department with dizziness. She was found to have an acute chronic kidney injury complicated by a complete heart block (CHB). She received a transvenous pacemaker and was taken for hemodialysis (HD) with complete resolution of her heart block. The following day, she was noted to be symptomatic and bradycardic. A repeat electrocardiogram showed a recurrence of the CHB. She was taken again for HD which led to the resolution of her conduction abnormalities. Electrophysiology was consulted and she had a permanent pacemaker implanted prior to being discharged.
RESUMO
To determine mortality and morbidity associated with coronary air embolism (CAE) secondary to complications of percutaneous lung biopsy (PLB) and illicit-specific risk factor associated with this complication and overall mortality, we searched PubMed to identify reported cases of CAE secondary to PLB. After assessing inclusion eligibility, a total of 31 cases from 26 publications were included in our study. Data were analyzed using Fisher's exact test. In 31 reported cases, cardiac arrest was more common after left lower lobe (LLL) biopsies (n=4, 80%, p=0.001). Of these patients who suffered from cardiac arrest, CAE was found more frequently in the right coronary artery (RCA) than other locations but did not reach statistical significance (n=5, 62%, p=0.39). At the same time, intervention in the LLL was significantly associated with patient mortality (n=3, 60%, p=0.010). Of the patients who died, CAE was more likely to have occurred in the RCA, but this association was not statistically significant (n=4, 57%, p=0.33). LLL biopsies have a statistically significant correlation with cardiac arrest and patient death. More research is needed to examine the effect of the air location in the RCA on patient morbidity and mortality.