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Cardiac Arrest CA is an important cause of death, 50 percent occurring outside hospitals. One-half of these patients are found in Ventricular Fibrillation VF or pulseless ventricular taquicardia. Within this group, better survival is achieved with early defibrillation less than four to eight minutes.
Early BLS is also associated with better survival, by delaying the deterioration of the cardiac rhythm to asystole. We describe the case of a 80 years old man, who suffered CA shortly after arrival to his local health department, for an appointment with his GP. Several weeks before he began to suffer from typical effort angina and that day he was feeling unwell. The victim was defibrillated with a J shock and BLS resumed. When orotracheal intubation was attempted, masseter muscle contraction was noticed, so BLS was discontinued for reevaluation.
The rhythm had become a wide QRS tachycardia with pulse and the victim recovered spontaneous breathing. Partial consciousness was recovered Glasgow Coma Score: The patient was transferred to an emergency department. Half an hour later, as he recovered consciousness fully, he complained of chest pain. Laboratorial tests showed cardiac troponine I 0. A coronary angiography performed urgently, disclosed significant left main plus three vessel — coronary artery disease.
Left anterior descending artery LAD was occluded, with late retrograde flow. Eighteen hours after the CA, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the proximal LAD. Post-operative course was uneventful and the patient was discharged on day 7 after the procedure. Sixteen months later, he remains asymptomatic.
