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Percutaneous Left Ventricle Assistance device – a rescue for Status Epilepticus
Session:
Casos Clínicos: Arritmias e Dispositivos Cardíacos
Speaker:
Diogo Santos Da Cunha
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.4 Arrhythmias, General – Treatment
Session Type:
Sessão de Casos Clínicos
FP Number:
---
Authors:
Diogo Santos Da Cunha; Gonçalo J. Morgado; João Mirinha Luz; Nazar Ilchyshyn; Oliveira Baltazar; Mariana Martinho; Bárbara Ferreira; João Grade Santos; Ana Cristina Martins; Rita Calé; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt">We report the case of a 51-year-old woman, active smoker, with known history of dyslipidemia, generalized epilepsy, depressive syndrome and histrionic personality disorder, who was brought to the emergency department in refractory status epilepticus. The patient was found unconscious at home, and there was no record of any prior complaint prior to the episode, including chest pain. As the patient arrived in Glasgow Coma Scale of 3 and orotracheal intubation was attempted, the patient went into sudden cardiac arrest in pulseless electrical activity. One cycle of advanced cardiac life support was applied with successful return of spontaneous circulation. When Cardiology was paged, the patient was hypotensive with poor peripheral perfusion, in sinus rhythm without significant electrocardiogram changes, and the echocardiogram revealed severe hypokinesia of all mid-basal segments of the left ventricle (LV) with severe systolic dysfunction (LV ejection fraction of 25%), without other relevant features. The patient underwent emergent coronary angiogram which excluded acute coronary syndrome; head and chest CT ruled out stroke, aortic dissection and pulmonary embolism. Blood work demonstrated high sensitivity T-troponin of 885 ng/L and NTproBNP of 19934 pg/mL. At this point, Stress Cardiomyopathy (SCM) induced by the status epilepticus was admitted as the most likely diagnosis. SCM is an acute reversible cardiac injury, often associated with sudden emotional and/or physical stress, more frequent in post-menopausal women; the proposed mechanism includes an excess of circulating endogenous catecholamines. As cardiogenic shock persisted and exogenous catecholamines might be deleterious, mechanical circulatory support was the next best option. A transcatheter LV assistance device (<em>Impella CP</em>®) was implanted via right femoral artery with success. From that moment on, significant hemodynamic and clinical improvement was progressively noted, with concomitant lowering of cardiac biomarkers, recovery of neurologic status and weaning of mechanical ventilation. The <em>Impella CP</em>® device was removed after four days without complications. The echocardiogram at day 5 post device retrieval disclosed a slight recovery in LVEF (35%). The patient was discharged at day 6 after admission. The cardiac MRI 14 days post-discharge indicated an LVEF of 51% with almost total recovery of segmental wall motion abnormalities, with no areas of edema or late gadolinium enhancement. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt">(Note: there is cardiac imaging documenting the case - echo, coronary angiography, impella implantation, MRI -, but the SPC platform does not allow to send it annexed to the abstract, that is why I just sent this annexed document with static images of the MRI. In case of acceptance to presentation in the congress, I would be able to show them all, which obviously enriches the case.)</span></span></span></p>
Slides
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