'Hearing hooves, finding zebras': the differential diagnosis of cardiac arrest precipitated by chest pain in the postpartum woman.
BMJ Case Rep
; 11(1)2018 Nov 28.
Article
in En
| MEDLINE
| ID: mdl-30567125
ABSTRACT
We describe the case of a 3-week postpartum 27-year-old woman who presented with chest pain to the emergency department shortly before developing cardiac arrest with refractory ventricular fibrillation. She was initially misdiagnosed and treated for presumed pulmonary embolism (PE) with thrombolysis. A total of 14 direct current cardioversion shocks were given and return of spontaneous circulation (ROSC) was achieved post thrombolysis. Subsequent CT pulmonary angiography excluded PE. A post-ROSC ECG demonstrated anterolateral ST elevation and she was transferred to the local cardiac unit for angiography. This revealed extensive dissection of the left anterior descending artery (LAD) with proximal occlusion. The diagnosis therefore was pregnancy-associated spontaneous artery dissection, a type of acute coronary syndrome. She received percutaneous intervention to her LAD with five drug-eluting stents. The patient survived and was discharged 5 days later. Her ventricular function is now grossly impaired, and had the correct diagnosis been arrived at sooner, this loss of function would have been less severe.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pulmonary Embolism
/
Ventricular Fibrillation
/
Chest Pain
/
Coronary Artery Disease
/
Coronary Angiography
/
Acute Coronary Syndrome
/
Heart Arrest
Type of study:
Diagnostic_studies
/
Etiology_studies
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
BMJ Case Rep
Year:
2018
Type:
Article
Affiliation country:
United kingdom