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Cardiogenic shock in a patient with recurrent wide-complex tachycardia
Author(s) -
Hanno Amberger,
Laurent Roten,
Tobias Reichlin
Publication year - 2020
Publication title -
cardiovascular medicine
Language(s) - English
Resource type - Journals
eISSN - 1664-204X
pISSN - 1664-2031
DOI - 10.4414/cvm.2020.02109
Subject(s) - cardiogenic shock , medicine , cardiology , tachycardia , shock (circulatory) , intensive care medicine , myocardial infarction
A 54-year-old male patient was brought to the emergency department with palpitations, dizziness and shortness of breath late on a Friday evening. He had a history of palpitations for a few years, but no other past medical history. The 12-lead ECG revealed a very fast wide-complex tachycardia (WCT) of 250 bpm (fig. 1). Because of haemodynamic instability with a blood pressure of 50/30 mm Hg, directcurrent cardioversion was performed and restored sinus rhythm (fig. 2) with resolution of symptoms. The patient was admitted to the intermediate care unit for surveillance. After a few hours, another, but slower, WCT started (fig. 3). This was haemodynamically stable at first, but soon degenerated into atrial fibrillation with a very rapid ventricular response, requiring cardioversion again. Over the course of the subsequent 48 hours, the fast WCT recurred repeatedly with heart rates above 200 bpm (often irregular) despite initiation of amiodarone, beta blocker and calcium channel blocker therapy. Multiple direct-current cardioversions were performed but could not prevent development of progressive cardiogenic shock with multiorgan failure.

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